Building a Culture of Safety in Healthcare

What is Culture of Safety?

Culture of Safety is how an organization’s culture supports and promotes patient safety. It refers to the values, beliefs, and norms that are shared by healthcare practitioners and other staff throughout the organization that influence their actions and behaviors. Patient safety culture can be measured by determining the values, beliefs, norms, and behaviors related to patient safety that are rewarded, supported, expected, and accepted in an organization. It is also important to note that culture exists at multiple levels, from the unit level to the department, organization, and system levels. All this together creates a commitment to safety and works towards minimizing patient harm.

By having a solid culture of safety program within the organization, patients have a reduced risk of serious injury and harm while in the care of the organization because the leaders, managers, and staff focus on safety in a more organized manner that both identifies gaps or risks and focuses on closing those gaps or reducing those risks. Reducing errors improves the overall quality of health care received by patients, as well as keeping staff safe in the workplace. This is what you find in an organization that promotes high reliability in their organization.

Organizations that promote a culture of safety will:

• Acknowledge the high-risk nature of an organization's activities and the determination to achieve consistently safe operations.
• Promote a blame-free environment where individuals can report errors or near misses without fear of reprimand or punishment.
• Encourage collaboration across ranks and disciplines to seek solutions to patient safety problems.
• Encourage leaders to model the expected behaviors.
• Commitment to financial resources to address safety concerns.
• Communicate policies and procedures in a manner that focuses on how they contribute to keeping staff and patients safe.
• Positively recognize staff members who identify and report safety issues.
• Routinely review safety measures and inspect workplaces to ensure they comply.

What Can You Do To Improve An Organizations Culture of Safety

• Appoint a Safety Champion for Every Unit

• • Seek volunteers from the staff; don’t assign the task to a reluctant staff member.
  • Empower the safety champion to come up with quick solutions to certain problems, such as getting equipment fixed or replaced.
  • Remind staff members that the safety champion is their ally, not an informer or a disciplinarian.
  • Train the safety champion in safety concepts such as Human Factors Engineering — the science of why people make mistakes.
  • Bring safety champions from different units together regularly to share information.
  • Check with staff members occasionally to see how well the safety champion is meeting their needs.
  • Check with the safety champion to ensure they are feeling supported in their role.

• Conduct Leadership Rounds Specifically for Patient Safety

• • Get a commitment from senior executives for an hour every week to conduct safety rounds. These rounds should occur every week. Rescheduling or canceling should be avoided at all costs to avoid staff perceiving leaders as not engaged.
  • Keep discussions focused on safety; don’t dilute the safety message by trying to cover other topics.
  • Involve all the senior executives in the organization, not just the chief executive officer.
  • Remind Senior Leaders to pay attention to their body language during rounds.
  • Communicate with managers so they understand why senior executives are visiting their departments.
  • Make sure that senior executives follow up and provide feedback to staff about issues raised during the leadership rounds.
  • Institute regular safety briefings.  Pass along issues raised in the briefings (with names of the contributing staff members withheld) to the executives to talk about on their leadership rounds.
  • Take a digital camera. It has been wonderful for PowerPoint presentations to staff and quality council meetings. Pictures are worth a thousand words.
  • Prior to leaving the unit, have the executive summarize the issues and ask staff to prioritize 2 to 3 items to be addressed.

• Have Daily Safety Briefings

• • Reinforce the non-punitive aspect of the discussion repeatedly, especially during the first few briefings.
  • Keep the briefings short.
  • Adjust the frequency and time of day if the staff asks you to. Be sure that you cover all shifts.
  • Collect detailed information about issues raised by staff.
  • Institute weekly leadership rounds as well as the regular staff safety briefings for best results.

• Have a User-Friendly Reporting System

  • Communicate the reporting policy to the staff during leadership rounds.
  • Adopt a non-punitive reporting policy.
  • Reinforce the non-punitive management philosophy by asking staff members who have reported safety issues, near misses, or adverse events to share their story with others, including how the management supported them.
  • Consider staff members’ safety reports — and their involvement in other safety initiatives — favorably in their annual performance reviews.
  • Train managers to identify human factors and system failures in errors and adverse events.
  • Let reporters know something will be done with their report, that the system works. That way they feel that their report will be useful.

• Create an Adverse Event Response Team

• • Conduct training and drills to develop an organized response for actual events.
  • Train enough staff members to have in-house response capability 24 hours a day, seven days a week.
  • Have a backup group of additional responders in case the people involved in the event are on the regular response team.
  • Meet with the response team and those involved in the adverse event to discuss ways to improve the response process.
  • Remember to have the response team support even medical staff who are not employees. Invite non-employed medical staff to join the response team.

To summarize, a culture of safety is all about the establishment of safety as an organizational priority, teamwork, patient involvement, openness/ transparency, and accountability. A solid safety program will improve staff/ physician morale, patient satisfaction and motivate staff to want to do better.

As you can see, there are many ways to improve your culture; above are a few of those ways, a starter package, so to speak. Enjoy the journey, and in time you will see results and don’t forget to celebrate those successes!

Reference

• PSNet, Culture of Safety, September 7, 2019.
• Lamb, R. M., Studdert, D. M., Bohmer, R. M, Berwick, D.M., & Brennan, T.A. (2003). Hospital disclosure practices: Results of a national survey. Health Affairs, 22, 73- 83.
• Culture of Safety in Healthcare: 5 Steps to Success, Caroline Duncan : Jul 14, 2022.
• Develop a Culture of Safety, IHI website.

To learn more about Culture of Safety contact the Courtemanche and Associates Team at 704-573-4535 or email us at info@courtmanche-assocs.com.