ABSTRACT
Background Positive safety culture is a key characteristic of a high-reliability organization; it is the leading service excellence standard and highest priority of The University of Texas MD Anderson Cancer Center. However, understanding the importance and impact of safety event reporting was limited at the MD Anderson campus in Sugar Land, Texas. Therefore, we implemented the Secure, Attentive, Focused, Engaged (SAFE™) initiative to create, foster, and continuously improve safety culture throughout the campus, with a secondary goal of impacting patient experience. Here, we review the SAFE™ initiative and its impact on our safety culture and patient experience. Methods The SAFE™ initiative was conceptualized and implemented in April 2017 by the leadership team at MD Anderson Cancer Center in Sugar Land. This initiative completely restructured our safety reporting and follow-up processes through leading by example, open safety meetings, transparent communication, emphasis on processes rather than people, and follow-up on any safety event entered or issue raised. We recorded quantitative measures and qualitative improvements, such as increased engagement and improved staff morale, using the results of institutional safety surveys in 2018 and 2020, which included a comparison to Agency for Healthcare Research and Quality's (AHRQ) national benchmarks and Press Ganey® patient experience scores. The AHRQ national benchmarks are based on the culture of safety surveys that measure staff views on safety, while the Press Ganey® patient experience scores measure patient perception. The SAFE™ initiative was then implemented at three additional MD Anderson Cancer Center campuses. Results During the data collection period of April 2017 to December 2021, we observed a sustained increase in safety event reporting at our campus, from 7.17 to 15.49 reports per month. We also observed a qualitative increase in safety meeting engagement and a higher participation rate in the institution-wide safety survey compared to MD Anderson Cancer Center overall. MD Anderson Cancer Center in Sugar Land scored above the national benchmarks in nine of the 13 domains in 2018 and all domains surveyed in 2020. Patient experience scores, measured by Press Ganey®, increased annually, with 2017, 2018, 2019, and 2020 fiscal year top box scores averaging 80.6%, 83.9%, 85.9%, and 86.4%, respectively. Two of the additional locations showed improvement from 2018 to 2020 in the institution-wide Culture of Safety Employee Survey and scored above the AHRQ's national benchmarks in all the domains. The third location showed improvement from 2018 to 2020 on the institution-wide Culture of Safety Employee Survey in 11 of 15 domains and scored above the AHRQ's national benchmarks in all except one domain. The greatest improvements were error feedback, employee safety, and communication openness. Conclusions Positive safety culture is a requirement for a health care organization to be designated as a high-reliability organization. At MD Anderson Cancer Center in Sugar Land, we implemented an initiative that had a meaningful impact on the creation of a positive safety culture and was successfully scaled to additional locations.
ABSTRACT
BACKGROUND: Although specialty outreach clinics have been associated with improved outcomes and access to care, their role for patients with non-small cell lung cancer (NSCLC) has not been described. We sought to characterize perceptions of the utility of a specialty outreach clinic among patients with suspected NSCLC. METHODS: Surveys were administered to patients who were suspected to have NSCLC and were seen at an outreach thoracic surgery clinic (2016 to 2017). The clinic was located approximately 20 miles from the academic cancer center. RESULTS: Sixty-nine patients completed surveys. The median distance traveled to the clinic was 43.5 miles (interquartile range: 5.0 to 111.3 miles). Among patients traveling 50 miles or more, the overwhelming majority (27 of 32 patients, 84.4%) cited physician expertise as the primary benefit of treatment at the clinic. Moreover, compared with patients living in closer proximity, they were more willing to travel 100 miles or more to have surgery (71.0% versus 26.7%, p = 0.001) or to consult with a surgeon (71.0% versus 25.8%, p < 0.001). Patients for whom it was very important to receive care close to home (33 of 68 patients, 48.5%) were less willing to travel 100 miles or more for consultation (surgeon: 33.3% versus 65.6%, p = 0.011; medical oncologist: 33.3% versus 65.6%, p = 0.011; radiation oncologist: 33.3% versus 64.5%, p = 0.015) and for treatment (surgery: 33.3% versus 65.6%, p = 0.011; chemotherapy: 36.7% versus 60.7%, p = 0.067; radiotherapy: 33.3% versus 64.3%, p = 0.018). CONCLUSIONS: Many patients value receiving oncologic care close to home and are sensitive to distance required to travel for care. Thoracic surgical outreach clinics may provide a benefit for patients with lung cancer in the settings of initial consultation, preoperative care, and postoperative care.
