SAFE™ Initiative: A Step Closer to Positive Safety Culture and Improved Patient Experience

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.