The #1 topic they didn’t teach you in Paramedic School: Culture

I have been working with the Center for Patient Safety (CPS) for about four months, and I’m learning something new every day.  As a Paramedic, patient safety has always been a high priority, but I didn’t know how an organization’s culture could impact the delivery of care.

Much of what we do at CPS is to educate, inform and help others make the connection between culture and safety.  While that might sound simple, it’s a rather complicated task.  Also, it’s about finding leaders and providers that are willing to listen and learn about these concepts that aren’t taught in Paramedic school.

Culture is comprised of many things including the collective beliefs, attitudes, perceptions, and values of the employees and the entire organization. How would you describe your organization’s culture? Did you know that you can measure it?

The EMS Safety Culture Assessment provided by CPS offers an organization the tools to understand their strengths and opportunities when it comes to their safety culture.  Many use it as a tool before implementation of just culture or as a baseline measurement of the values within their organization and then come back a year later and re-measure to see how their work has improved the safety culture.

The Safety Culture Assessment can also help with local or regional quality improvement projects and initiatives as it measures areas such as patient handoffs and communications between healthcare providers. These are just a few reasons why measuring your culture should be something that is not only accepted by EMS but expected in EMS just as it is in other healthcare settings.

Years ago I worked as a flight Paramedic and the safety culture in an air-based service seemed to be more advanced since it was linked to aviation. It was acceptable to turn down a flight and have a safe time-out due to severe exhaustion or if something didn’t seem right. As a ground paramedic, a safety time-out didn’t exist and many had never heard of it. Today, many years later, safety precautions like time-outs, are more common and practiced within a growing number of ground organizations.

One of the interesting things I get to do in my new position is listen to how leaders and providers describe their safety culture.  However, just like the safety time-out, many have never thought about it or can’t describe it.

One agency recently completed the EMS Safety Culture Assessment and learned of staff concerns regarding a change from 24-hour shifts to 48-hour shifts and how that change could impact patient and provider safety. As a result, the ground service implemented a time-out policy that addresses exhaustion, a pro-active approach to building a safe culture.

Do you have a safe organization where employees come to you with concerns about an unsafe situation or when a mistake occurs? Alternatively, are you the Chief that believes near misses and mistakes do not happen within your organization? How do you truly know the thoughts and feelings of the employees within your organization if you haven’t assessed the culture or given them the opportunity to speak up without the fear of repercussions from their colleagues and administration?

Our mission at the Center for Patient Safety is: Reducing preventable harm, but what does that mean and how do you accomplish that? The EMS Safety Culture Assessment is the first step in recognizing and learning about the culture component of your organization.

The EMS Safety Culture Assessment provided by CPS gives employees a voice that is trusted and de-identified so they can speak up without fear of retribution from colleagues or punishment from administration. The assessment also helps administration recognize the need to fulfill a safe practice and utilize the results to make positive changes within their organization.

Shouldn’t all first responders feel safe within the environment they call their second home?

Please contact me so we can start your EMS safety journey today! Your employees and your community are counting on you!

Shelby Cox

Administering a Culture Survey


Why assess your culture?

You can improve what you measure. Without measuring, you have no way to know if you are improving.

These statements are especially true when it comes to assessing your culture. It may be easy to take a quick poll of staff and infer their perceptions to that of the rest of your organization’s employees, but there’s no certainty in your results. Using a standardized survey tool can provide measurable and meaningful feedback.

Another reason to assess your culture is because many regulatory and certifying bodies now require or recommend measurement of an organization’s patient safety culture. This is because they, too, recognize the clear connection between strong cultures with open communication and the effective implementation and sustainability of patient safety and quality improvement programs.

  • The Joint Commission
  • Leap Frog
  • CMS Merit-based Incentive Payment
    System (MIPS)
  • CMS Quality Assurance and Performance Improvement (QAPI)

The Center for Patient Safety has been administering culture assessments since 2010, and we understand the most successful organizations have a fine-tuned process for administering the survey and analyzing their results. In this article, we’ll discuss some of the most pertinent planning details when preparing to launch a survey. Subsequent articles will include diagnostic tips for evaluating your survey data.

While standard online survey templates may ease the burden of survey administration, there are four key areas that, if addressed upfront, can save time, resources, and frustration in the long run.

1. Which Tool.
The Center has always supported the Agency for Healthcare Research and Quality’s (AHRQ) Survey on Patient Safety (SOPS) tools though there are many other surveys that can provide a similar analysis. The SOPS tools have been developed for a multitude of healthcare provider types with specific, relevant questions asked, based on varying care settings, such as nursing homes, hospitals, ambulatory surgery centers, pharmacies and medical offices. These surveys have also been psychometrically tested and validated and are available in more than 40 languages.

2. Which Medium.
How do you normally administer surveys to your staff? Are they at ease with an online version, or are they most comfortable with a paper survey? While this seems like an insignificant question, it is quite important. If staff are fearful, they will hesitate to write unfavorable feedback on a paper survey because they think their handwriting will be recognized. However, they may also think the organization will track their online response back to them for purposes of punishment. Using a third party vendor often works best and creates a neutral environment for staff to respond. Consider offering a combination of online and paper surveys. Allow staff to take the survey in a confidential environment with varying options for submitting them. Providing options other than submitting them to their manager increases anonymity, resulting in truer results.

3. Custom Questions.
We often get question-happy when it comes to surveys. It’s efficiency at its finest: “While we have our staff’s attention, let’s just go ahead and ask a few more questions, like what they thought about the EHR implementation, their employee engagement for the year and what sport the organization should have at the next company picnic.” This is a big no-no. If you’re using a standardized survey, keep the list of questions short and relevant. The AHRQ SOPS ask about 45-50 questions and can take up to 15 minutes to complete. Limit additional questions to no more than five and keep it related to culture. More than five questions on an unrelated topic will cause confusion and create survey fatigue.

4. Promotion.
Staff won’t do something if they don’t know they need to do it. Put a little effort into marketing the survey and you’ll get a very valuable return. The more staff that take your survey, the more accurately your results will reflect the culture of your organization. This in turn gives you better data to analyze. Plan with your marketing department, do a search on Google, or harness your creativity to develop posters and email templates. Ask your CEO or President to write a brief memo about the value and importance of all staff taking the assessment and their desire to see honest feedback. Put a link to the survey on your Intranet; distribute surveys at a monthly staff meeting; offer a certificate for a free drink for turning in a completed survey; or host a pizza party if you reach your target response goal. These are small tokens of appreciation that can have a big impact on getting valuable insight.

In Summary 

Your time will be most efficiently spent analyzing the results and preparing action plans post-survey, so addressing these four areas upfront will remove many of the headaches that can go along with planning and administering a survey. If a third-party option is a better choice for you, please contact the Center for Patient Safety to discuss our custom options. We’ll even help in the analysis of your survey results. Find out more information about our survey services.

The Joint Commission released Sentinel Event Alert #57

The Joint Commission released Sentinel Event Alert #57 this week:  The Essential Role of Leadership in Establishing a Patient Safety Culture.

The Center for Patient Safety supports the 11 patient safety tenets and provides services and supports to help health care providers across the continuum improve patient safety.  For additional information contact us.

It’s Patient Safety Awareness Week – #PSAW2017

The Center for Patient Safety encourages providers to use the week as a great way to remind the staff and community of their commitment to safety.
It should be a time of celebration of successes, but also a time of reflection.

In recognition of the week, and the efforts that continue every day throughout the year, the Center for Patient Safety is offering a 20% discount on the already affordable safety culture survey services. Download a proposal with sample feedback reports and an online sample survey link. We encourage the use of the survey as a diagnostic tool to assess your culture. Get started today and take advantage of the offering!

Several available toolkits can support your improvement efforts. It’s easy to start with tools that have already been developed and proven successful:  10 Patient Safety Tips for Hospitals

We also want to remind you that consumer involvement is important to ensure a successful patient safety program. The Agency for Healthcare Research and Quality provides several flyers and videos that can complement your events and programs during Patient Safety Awareness Week:


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The Center for Patient Safety believes that collaboration and sharing are the best ways to drive improvement. We strive to provide the right solutions and resources to improve healthcare safety and quality.