Cultural improvement at Providence St. Peter Hospital

Providence St. Peter Hospital in Olympia, Washington, is part of Providence Health & Services, a not-for-profit network of hospitals, medical clinics, physicians, health plans , and affiliated services in Alaska, California, Montana, Oregon, and Washington. The hospital is a 390-bed acute and outpatient care facility, with more than 20,000 annual admissions and more than 5,000 annual inpatient surgeries.

In 2007, Providence St. Peter Hospital launched the Accelerating Clinical Transformation (ACT) initiative to promote the discovery, refinement, and spread of leading clinical practices. This initiative provides grant funding to facilitate innovation. Grant recipients document and communicate their findings to ensure widespread adoption across the system.

In 2009, the Providence St. Peter Hospital surgical acute care unit became the pilot site for the ACT Patient Safety Pilot Study. This unit had a history of high turnover among nurse managers, and low employee and patient satisfaction. To measure and improve their culture, Providence St. Peter Hospital partnered with Pascal Metrics to administer the Safety Attitudes Questionnaire (SAQ). Following administration of the SAQ in 2009, Michael Leonard, M.D., of Pascal Metrics visited Providence St. Peter Hospital, attending their annual medical staff meeting to raise awareness of the upcoming safety culture initiative and to speak with leaders about their goals.

The SAQ scores for the unit were low. But the results helped Providence St. Peter Hospital leadership to identify opportunities for improvement through training. They targeted improved nurse/physician communication, an understanding of staff perceptions of leadership, and an increase in staff members’ comfort in speaking up.

As evidence of leadership commitment to the initiative, the hospital Chief Executive Officer, Chief Medical Officer, and physicians in the surgical acute care unit agreed to participate in the 4-hour training session conducted by Dr. Leonard. With an eye toward spreading improvements to other clinical service lines, other physician leaders attended the training. The goal was not only to improve the safety culture within the surgical acute care unit, but to develop tools and knowledge that could be deployed reliably across the entire organization.

Following the training session, unit and hospital leadership put the proposed changes in behavior and process into practice. The surgeons, who had formed a hospitalist group, became active partners in the effort to improve patient care and build a better environment for caregivers. Nurses and physicians began to participate in joint rounding to ensure close communication. Currently, all nurses in the unit participate in a safety and quality initiative as part of their ongoing professional development and their annual evaluation. For each new initiative undertaken, leadership continues to stress the importance of multidisciplinary interaction and accountability.

The results have been staggering. Whereas nursing students had once tried to avoid being assigned to the surgical acute care unit, they now actively lobby to do their clinical rotations there. Clinical and patient satisfaction metrics have improved. And when the SAQ was administered again in 2010, every survey domain showed significant improvement.

Moving forward, Providence St. Peter Hospital will target needed improvements in the intensive care unit, emergency department, and operating room. Hospital leadership will use the strategies, processes, and practices from the surgical acute care unit as the model for assessing, training, implementing, and evaluating needed changes.