Kaiser Permanente School of Anesthesia Uses AHRQ’s Surveys on Patient Safety Culture®, TeamSTEPPS®

Kaiser Permanente (KP) School of Anesthesia in Pasadena, California, uses AHRQ’s Surveys on Patient Safety Culture (SOPS®) to improve ambulatory care and expand doctoral students’ education. The school has used the SOPS hospital survey in the past and recently conducted an analysis of nationwide data from the SOPS survey for ambulatory surgery centers. Using the findings, school officials are working to improve Certified Registered Nurse Anesthetist (CRNA) training with TeamSTEPPS®.

AHRQ surveys are available for hospitals, medical offices, nursing homes, community pharmacies, and ambulatory surgery centers (ASCs). The ASC survey gives surgery centers the opportunity to assess the patient safety culture in their facilities. This survey is designed specifically for ASC staff, asking their opinions about the culture of patient safety where they work.

“Each year, KP School of Anesthesiology assigns projects students must complete for their Doctor of Nursing Practice degree. These projects are rigorous and clinically relevant to nurse anesthesiology,” explained Mark Gabot, D.N.P., CRNA, faculty advisor for the project. “I worked with the hospital SOPS survey a couple of years ago. This time, I wanted to do something on a larger scale. So, we reached out to AHRQ and were able to get access to the nationwide ASC data for 2021 through 2023. Both CRNAs and physician anesthesiologists had completed the surveys,” he said.

The team of three students and two faculty members chose the ASC project because nearly 70 percent of all surgical care in the United States is now performed in ASCs. These surgeries involve ever-increasing numbers of complex cases for patients with multiple health conditions. 

The project aimed to identify strengths and areas for improvement, as well as create best practice recommendations for patient safety from an anesthesia-informed perspective. 

According to Dr. Gabot, the team’s secondary analysis of data from AHRQ’s SOPS ASC database revealed some important information when looking at responses from certified registered nurse anesthetists and anesthesiologists:

• The highest composite measures were “communication about patient information” and “communication openness.”
• The lowest composite measures were “staffing, pressure, and pace” and “staff training.”
• Nearly 40 percent of anesthesia practitioners feel rushed when taking care of patients.
• About 15 percent of anesthesia practitioners do not feel that their ideas and suggestions are valued by their facility. 

Based on the survey results, the project team made the following recommendations:

• Use ASC SOPS and TeamSTEPPS regularly.
• Establish a “just culture” for all anesthesia practitioners (an atmosphere of trust where those who provide essential safety-related information are encouraged and where people are clear about what constitutes acceptable behavior).
• Implement a patient safety reporting system, standardized patient screening, and anesthesia patient safety task force.

TeamSTEPPS was developed jointly by AHRQ and the Department of Defense. It is an evidence-based system that aims to improve communication and teamwork skills among healthcare professionals, boosting patient safety and care. This customizable program helps optimize performance among teams of healthcare professionals, enabling them to respond quickly and effectively to whatever situations arise.

Based on the project results, the Kaiser Permanente School of Anesthesia is improving its TeamSTEPPS training program. “Every year, we conduct TeamSTEPPS training for our students to promote that just culture,” Dr. Gabot said. “Thanks to this project, we’re actually reformatting our TeamSTEPPS approach and education to reflect what the team found in the secondary analysis study.”