Leong pp presentation 11 27 07

ATTITUDE TOWARDS PATIENT SAFETY STANDARDS IN U.S. DENTAL SCHOOLS –A PILOT STUDY: 

ATTITUDE TOWARDS PATIENT SAFETY STANDARDS IN U.S. DENTAL SCHOOLS – A PILOT STUDY By Peggy Leong, DMD, MBA

Introduction: 

Introduction Concern about patient safety highlighted by the Institute of Medicine report, To Err Is Human: Building a Safer Health System, published in 1999. This report states that: Errors caused 44,000 – 98,000 deaths annually National costs of preventable adverse events are estimated to be $17 – $29 billion per year of which over half are healthcare costs

Introduction: 

Introduction Currently there is little attention paid to how patient safety issues may impact dental care. Morbidity, mortality and financial impact of human error in dental care would be less than seen in medicine. Lack of scrutiny can provide dental providers with a false sense of security.

Purpose of the Study: 

Purpose of the Study Definition: Safety Culture is the set of values, beliefs and norms about what is important, how to behave and what attitudes are appropriate when it comes to patient safety in a work group. Hypothesis: The Patient safety culture in U.S. Dental School Clinics is less developed than in U.S. hospitals.

Purpose of the Study: 

Purpose of the Study We used a patient safety culture survey to test our hypothesis. We chose U.S. dental school teaching clinics as our sites because of the impact of the clinics on the practice of future dentists. Being a part of the teaching organization, the clinics are only accredited for overall educational outcomes, not for patient safety.

Materials and Methods: 

Materials and Methods Study approved by the Internal Review Board of Harvard School of Dental Medicine Recruitment letter to schools listed in ADEA website (52) 8 agreed to participate, later 1 withdrew Agency for Healthcare Research and Quality (AHRQ) Selection of participants

Survey Instrument: 

Survey Instrument Overall perceptions of safety Frequency of Event reporting “Hospital survey on Patient Safety Culture” 48 randomly sorted questions on 12 areas Clinic management support in reporting and actions promoting patient safety Ability of the school to take action and learn from reported incidents

Survey Instrument: 

Survey Instrument Ability of the clinic to work cohesively Ability of all to speak freely Feedback to all about errors Non-punitive response to errors Sufficiency of staffing levels Climate of support in clinics

Survey Instrument: 

Survey Instrument Teamwork across work units 2003, survey pilot tested on 1,400 staff from 20 different hospitals across the U.S. Transferring patient care information (handoff and transitions) Data obtained from pilot were published on website as benchmarks

Survey process: 

Survey process 50 surveys sent to the 7 participating schools where they schools were to get volunteers from students, staff and faculty to fill out. (350) PI and Co-PI visited each school from July – October 2005. One day visit, reviewed the sites using the ambulatory care standards of the Joint Commission. (Mock Survey). Collected surveys.

Benchmark : 

Benchmark The percent of “positive responses” defined as agreeing or strongly agreeing with a positive statement or disagreeing or strongly disagreeing with a negative statement for each group was determined. If the percent of positive responses was 5% above the benchmark, it was considered “above average.”

Benchmark: 

Benchmark If the percent of positive responses was more than 5% below the hospital benchmark, it was considered “below average.” All results between 5% above or below the benchmark were considered average.

Results: 

Results 328 surveys were completed out of 350 sent. Demographics of the seven schools: Average class size: 61 (range of 30-85) 2 state supported, 2 partial public funded, 3 privately funded. All had clinic directors who were dentists

Results: 

Results Demographics: All schools had a person or committee to oversee quality assurance of patient care Age of schools ranged from 3 years to over 100 years

Results: 

Results Above Average: Overall Perceptions of Safety Management Support for Patient Safety

Results: 

Results Frequency of Events Reported Below Average: Ability of the school to take action and learn from reported incidents

Discussion: 

Discussion Below average sections Frequency of reporting – lack of a user friendly reporting system; perceived lack of impact; lack of feedback about usefulness of reporting Proactive activities – lack of robust analysis of incident reports, reactive postures

Discussion: 

Discussion Policy impact of this pilot data Weaknesses of the survey process and the hospital benchmark

Conclusion: 

Conclusion Need for further studies to develop new benchmarks for dental school clinics. Data demonstrates areas of perceived weaknesses in the patient safety culture of the dental schools visited. This data can help school leadership focus their improvement efforts.