Key concepts in each question of the PSCIT tool

Each question in each level split into key components

Patient Safety Leader Education and Training

Maturity Level 1. General information on patient safety, including how it is measured, policies and procedures, is provided to leaders.

  1. General information on patient safety is provided to leaders
  2. General information on patient safety policies and procedures is provided to leaders.
  3. General information on how patient safety is measured is provided to leaders.

Maturity Level 2. Leaders receive information about their role in improving patient safety. They receive nonrecurring knowledge-based training about leadership behaviors that promote patient safety.

  1. Leaders receive information about their role in improving patient safety .
  2. They receive nonrecurring training about leadership behaviours that promote patient safety .
  3. The training is knowledge-based .

Maturity Level 3. Leaders are taught interpersonal competencies (through skill-based training) to motivate colleagues and subordinates to improve patient safety.Training is recurrent (at least annual) and includes target setting to improve interpersonal skills.

  1. Leaders are taught interpersonal competencies (through skill-based training) to motivate colleagues and subordinates to improve patient safety.
  2. Training is recurrent (at least annual).
  3. Training includes target setting to improve interpersonal skills.

Maturity Level 4. Leaders receive mandatory individualized patient safety leadership development based on upward appraisal and evaluation.There is a formal ongoing evaluation of leaders' behavioral change.

  1. Leaders receive individualized patient safety leadership development based on upward appraisal and evaluation.
  2. The leadership development is mandatory .
  3. There is a formal ongoing evaluation of leaders' behavioural change.

Patient Safety Leader Performance Evaluation

Maturity Level 1. Promoting and assessing patient safety is included in the leaders' description. Leader performance is evaluated following a significant patient safety event (e.g. unexpected death) within their area of responsibility.

  1. Promoting patient safety is included in the leaders' job description
  2. Assessing patient safety is included in the leaders' job description
  3. Leader performance is evaluated following a significant patient safety event (e.g. unexpected death) within their area of responsibility

Maturity Level 2. There is a formal system in place to monitor performance and performance reviews are conducted for leaders. Leaders' performance is monitored through regular discussion of cases and outcomes.

  1. There is a formal system in place to monitor performance
  2. Performance reviews are conducted for leaders
  3. Leaders' performance is monitored through regular discussions of cases and outcomes

Maturity Level 3. Performance is routinely monitored using a variety of techniques (e.g. performance reviews, retrospective chart reviews). Input from colleagues is sought. Results from monitoring are discussed with individual being reviewed.

  1. Performance is routinely monitored using a variety of techniques (e.g. performance reviews, retrospective chart reviews).
  2. Input from colleagues is sought.
  3. Results from monitoring are discussed with individual being reviewed.

Maturity Level 4. Performance is monitored with leading indicators of patient safety. Ongoing and systematic observations of practice are conducted. The results from performance monitoring are used to develop individual learning plans. Peers routinely monitor each other's performance and provide constructive feedback for improvement.

  1. Performance is monitored with leading indicators of patient safety.
  2. Ongoing and systematic observations of practice are conducted.
  3. The results from performance monitoring are used to develop individual learning plans.
  4. Peers routinely monitor each other's performance and provide constructive feedback for improvement.

Workload Management

Maturity Level 1. Guidelines for the ratio of healthcare workers to patients are used to manage workload levels.

  1. Guidelines for the ratio of healthcare workers to patients are used to manage workload levels.

Maturity Level 2. Minimum healthcare worker-to-patient ratios are set based on available evidence and best practice. These levels are monitored closely and actions taken when mnimum standards are not met.

  1. Minimum healthcare worker-to-patient ratios are set.
  2. These worker-to-patient ratios are set based on available evidence and best practice.
  3. These worker-to-patient ratios are monitored closely.
  4. When worker-to-patient ratios do not meet minimum standards, actions are taken.

Maturity Level 3. In addition to evidence-based staffing levels, staffing levels take into consideration client group's needs and the experience and skill mix of the healthcare team.

  1. Staffing decisions take into consideration client group's needs.
  2. Staffing decisions take into consideration the experience and skill mix of the healthcare team.

Maturity Level 4. There is a holistic approach to workload management that considers all the demands placed on healthcare workers, such as the intensity of the work environment (i.e. the tasks to be performed, number of client interactions), client acuity, and the skill mix of the healthcare team. This approach involves providing additional resources for high-intensity situations, where treatment must be provided immediately and when members of the healthcare team are less experienced.

  1. There is a holistic approack to workload management that considers all the demands placed on healthcare workers.
  2. Staffing decisions take into consideration the experience and skill mix of the healthcare team.
  3. Workload management considers the intensity of the work environment.
  4. Workload management considers the tasks to be performed and number of client interactons.
  5. Workload management provides additional resources for high-intensity situations. where treatment must be provided immediately and when members of the healthcare team are less experienced.

Fatigue Management

Maturity Level 1. Fatigue is acknowledged as a patient safety risk factor. Fatigue-management efforts focus on limiting the number of hours worked per shift and per week.

  1. Fatigue is acknowledged as a patient safety risk factor.
  2. Fatigue-management efforts focus on limiting the number of hours worked per shift and per week.

Maturity Level 2. Strategic plan developed to redesign shift rotations (length and timing) that are increasing fatigue or are contrary to evidence and best practice.

  1. Strategic plan developed to redesign shift rotations (length and timing) that are increasing fatigue.
  2. Strategic plan developed to redesign shift rotations (length and timing) that are contrary to evidence and best practice.

Maturity Level 3. Fatigue-management plan (ensures shift rotation does not contribute to increasing healthcare worker fatigue) is implemented and monitored. This plan includes leading practices in fatigue management such as sleep contracts (formal agreements about the amount of sleep between shifts that encourage healthcare workers to rest while they are off shift.

  1. Fatigue-management plan (ensures shift rotation does not contribute to increasing healthcare worker fatigue) is implemented.
  2. Fatigue-management plan (ensures shift rotation does not contribute to increasing healthcare worker fatigue) is monitored.
  3. This plan includes leading practices in fatigue management such as sleep contracts (formal agreements about the amount of sleep between shifts that encourage healthcare workers to rest while they are off shift).

Maturity Level 4. Fatigue is identified as a form of impairment influencing cognitive performance (e.g. decision-making, digit span). Performance is routinely monitored using validated instruments to provide information on the level of impairment and enables healthcare workers to self-assess their performance and take remedial action (e.g. request support from colleagues).

  1. Fatigue is identified as a form of impairment influencing cognitive performance (e.g. decision-making, digit span).
  2. Performance is routinely monitored using validated instruments to provide information on the level of impairment.
  3. Monitoring enables healthcare workers to self-assess their performance.
  4. Self-assessment enables healthcare workers to take remedial action.

Resource Management: Training

Maturity Level 1. Information about resource management is provided to promote working effectively within a team environment.

  1. Information about resource management is provided to promote working effectively within a team environment.

Maturity Level 2. Knowledge-based interdisciplinary resource management training is provided.

  1. Interdisciplinary resource management training is provided.
  2. The interdisciplinary resource management training provided is knowledge-based.

Maturity Level 3. Skill-based (includes practice and feedback) resource management training is provided. The training program is developed/adapted to address the specific needs of the interdisciplinary team and is based on analysis of team working challenges.

  1. Skill-based (includes practice and feedback) resource management training is provided.
  2. The training program is developed/adapted to address the specific needs of the interdisciplinary team.
  3. The training program is based on analysis of team working challenges.

Maturity Level 4. Resource management training includes practice in a simulated environment and is followed by behavioural observation of performance using validated indicators. Feedback is provided to all individuals after training, and a formal evaluation of the training's effectiveness is conducted.

  1. Resource management training includes practice in a simulated environment.
  2. Practice in a simulated environment is followed by behavioural observation of performance.
  3. Behavioural observation of performance uses validated indicators.
  4. Feedback is provided to all individuals after training.
  5. Formal evaluation of the training's effectiveness is conducted.

Organizational Learning

Maturity Level 1. Events that result in significant harm (e.g. wrong-site surgery) are investigated, and actions are specified to prevent the occurrence of this specific event.

  1. Events that result in significant harm (e.g. wrong-site surgery) are investigated.
  2. Actions are specified to prevent the occurrence of this specific event.

Maturity Level 2. All event reports are investigated using validated tools and processes (e.g. root-cause analysis). Patient safety improvement actions are identified from the investigation and implementation tracked.

  1. All event reports are investigated using validated tools and processes (e.g. root-cause analysis).
  2. Patient safety improvement actions are identified from the investigation and implementation tracked.

Maturity Level 3. An integrated investigation system is implemented (e.g. incident reporting system, retrospective chart reviews and clinical audit process). Detailed results of investigations for each department are discussed with staff on a regular basis, and summary results are shared across the organization.

  1. An integrated investigation system is implemented (e.g. incident reporting system, retrospective chart reviews and clinical audit process).
  2. Detailed results of investigations for each department are discussed with staff on a regular basis.
  3. Summary results of investigations are shared across the organization.

Maturity Level 4. A comprehensive organizational learning system is in place that includes incident reporting, retrospective chart review and audits. The organization learns from both negative and positive outcomes by identifying the practices that protect patients as well as those that increase risk.

  1. A comprehensive organizational learning system is in place that includes incident reporting, retrospective chart review and audits.
  2. The organization learns from both negative and positive outcomes by identifying the practices that protect patients.
  3. The organization learns from outcomes by identifying the practices that increase risk.

Incident Reporting

Maturity Level 1. Paper incident report forms are available to enable staff to report patient safety events and concerns.

  1. Incident report forms (paper) are available to enable staff to report patient safety events and concerns.
  2. Electronic reporting system is available to enable staff to report patient safety events and concerns.

Maturity Level 2. Electronic incident reporting system (either paper or electronic) is in place. Training on how to use the system is provided to all staff. Learning from reported incidents is used in patient safety training. Reports have the option for individuals to identify themselves so that additional information about the incident can be obtained.

  1. Training on how to use the system is provided to all staff.
  2. Learning from reported incidents is used in patient safety training.
  3. Reports have the option for individuals to identify themselves so that additional information about the incident can be obtained.

Maturity Level 3. Independent incident reporting system is used to facilitate confidential (not anonymous) reporting. Managers identify common themes from the reports and discuss them at department meetings. There are mechanisms in place to provide information to all staff (e.g. monthly summaries are provided to all staff).

  1. Independent incident reporting system is used to facilitate confidential (not anonymous) reporting.
  2. Managers identify common themes from the reports.
  3. Managers discuss the reports at department meetings.
  4. There are mechanisms in place to provide information to all staff (e.g. monthly summaries are provided to all staff).

Maturity Level 4. Incident reporting system includes detailed description of the event. Events are coded by a human factors expert and folow-up discussions (e.g. by telephone) are conducted with the person who reported the incident. There is a formal process in place to track every incident and the outcomes associated with it. Incidents are used as learning tools; each incident is described to all staff members and the actions resulting from the report are explained.

  1. Incident reporting system includes detailed description of the event.
  2. Events are coded by a human factors expert.
  3. Follow-up discussions (e.g.by telephone) are conducted with the person who reported the incident.
  4. There is a formal process in place to track every incident and the outcomes associated with it.
  5. Incidents are used as learning tools.
  6. Each incident is described to all staff members and the actions resulting from the report are explained.

Disclosure

Maturity Level 1. Disclosure policy in place as per the CCHSA guidelines*.

  1. Disclosure policy in place as per the CCHSA guidelines*.

Maturity Level 2. Disclosure training offered to all staff (including physicians) including requirements under the policy.

  1. Disclosure training offered to all staff (including physicians) including requirements under the policy.

Maturity Level 3. Disclosure training is given to all staff (including physicians). Patients and families of those involved in an adverse event provide input into the training and are consulted on an ongoing basis to seek feedback on how disclosure is managed.

  1. Patients and families of those involved in an adverse event provide input into the training.
  2. Patients and families of those involved in an adverse event are consulted on an ongoing basis.
  3. Patients and families of those involved in an adverse event give feedback on how disclosure is managed.

Maturity Level 4. Use of retrospective chart audit to assess quality (and extent) of disclosure when harm has occurred.

  1. Use of retrospective chart audit to assess quality (and extent) of disclosure when harm has occurred.

Safety Analysis Systems

Maturity Level 1. Safety analysis tools are used for major events. For example, retrospective analysis tools (e.g. root-cause analysis) are used to investigate the causes of events that resulted in significant harm (e.g. wrong-site surgery), and prospective analysis tools are used when planning major organizational changes such as a new building.

  1. Safety analysis tools are used for major events.
  2. Retrospective analysis tools (e.g. root-cause analysis) are used to investigate the causes of events that resulted in significant harm (e.g. wrong-site surgery).
  3. Prospective analysis tools are used when planning major organizational changes such as a new building.

Maturity Level 2. Safety analysis tools are used frequently. The analysis is led by patient safety specialists with involvement of healthcare workers.

  1. Safety analysis tools are used frequently.
  2. The analysis is led by patient safety specialists.
  3. The analysis involves healthcare workers.

Maturity Level 3. A wide range of healthcare workers are competent in using safety analysis tools. Healthcare workers regularly use these tools to learn from incidents and identify ways of improving patient care.

  1. A wide range of healthcare workers are competent in using safety analysis tools.
  2. Healthcare workers regularly use these tools to learn from incidents and identify ways of improving patient care.

Maturity Level 4. Safety analysis systems are integrated into the routine activities of healthcare workers.

  1. Safety analysis systems are integrated into the routine activities of healthcare workers.
  2. The effectiveness of the system is monitored. For example, actions identified during a prospective analysis are tracked to ensure they were implemented and worked as intended.
References:
  1. Fleming M, Wentzell N. Patient safety culture improvement tool: development and guidelines for use. Healthcare Quarterly 2008; 11 (3 Spec No):10-15. (pdf:11pp)