Submitted by Bill Winn, General Manager, National EMS Pilots Association
The air medical transport community in general is a leading example of an industry that is continuously engaged in the process of self-evaluation and improvement. Nearly every patient transport operation is subject to an after-action review of what went right, and what could have been done better. For many (perhaps most) provider organizations this is a formal process that uses a written guideline to examine the crew’s performance with respect to the specific processes, protocols, and policies that apply to the two domains of care involved in every patient transport: flight safety and clinical care. Other than minor variations between air medical providers, these formal practices are much the same for nearly all organizations.
However, there is a less formal factor present in every organization that can either enhance or undermine the quality and efficacy of all practices associated with flight safety and clinical care. That factor is the safety culture of each organization. The safety culture is a complex system that has a real effect on the quality of communication, collaboration, compliance, reporting and quality improvement.
In the first quarter of 2016, the National EMS Pilots Association launched the CHAMPS survey for all air medical provider organizations in the United States. CHAMPS stands for Cultural Health Assessment and Mitigation Program for Safety. The title may be a little awkward, but it is descriptive of the intent and the end results of the survey.
Or, at least it is descriptive now. We believe the survey does a good job of assessing the current condition of a safety culture, but the reports provided with the first wave of 2016 surveys summarized an organization’s survey data in terms of response averages made by each of 10 functional roles found in organizations to the questions related to the 7 seven categories of safety culture defined by the survey. The use of average responses in the reports left questions hanging about the actual range of responses selected along the 5-point Likert scale used in the survey. Programs need to know about the number and positions of outliers when it comes to behaviors that can have a direct result on the safety or quality of their operations. The CHAMPS survey was designed to provide that information in a manner the protected the anonymity of every survey respondent, but those details were not readily available in the survey reports as they were originally formatted.
NEMSPA has now responded to the need to report the results of each survey in a manner that facilitates the identification and the mitigation of specific areas that need attention in any organization’s safety culture. The results of all future administrations of the CHAMPS survey will be provided in an online application named Qlik Sense, which is designed for the detailed evaluation of any kind of interrelated data. Each program that participates in the survey designates specific Data Custodians who will be the only persons that can access the Qlik Sense app containing the results of their own surveys. For purposes of comparison, each report also includes the aggregate responses of all surveys completed by all programs nationwide.
The example below is made from aggregate sample data. (The data does not represent any actual provider organization).
To generate this table, the Qlik Sense application was used filter the data to display only the negative responses to the survey questions. The data was also broken down in terms of service regions and in terms of the functional roles that make up the flight crews for this “sample” organization. This is a very useful view for any organization that has separate service regions with separate managers for the functional domains that make up the flight crews in each region. The table does not indicate a large number of negative responses, but it is enough to cause concern about whether a combination of risk-accepting crew members (e.g. Question #44) might be teamed up for the same flight. This doesn’t seem to be a concern for Region-2 flight crew members, but it is a possibility within Region-1. To mitigate this potential risk, some additional training or emphasis on the En-route Decision Protocol (EDP) and on conservative decision-making may be in order.
The questions that generated these negative responses were also compiled by the Qlik Sense app and are shown below.
The Qlik Sense survey data applications are now in the final stages of completion for each of the programs that participated in the 2016 administration of the CHAMPS survey. The next administration of the Survey is planned for the 1st quarter of 2018. Watch for future announcements with links to an online form to sign up to participate in the CHAMPS safety culture evaluation tool.