Pursuing an Optimal Culture of Safety

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Pursuing an Optimal Culture of Safety

• Core Curriculum for Patient Safety

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Why strive for an optimal culture of safety?

• Tens of thousands of people die each year and
  many more are injured due to preventable medical
  errors. (IOM)
• The organizational culture regarding patient
  safety is key to meaningful improvements.

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What do you think?

• Is your institution safe for patients?
• What would the patients say?

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Defining organizational culture

• Formally A pattern of basic assumptions--invented
  , discovered, or developed by a group as it
  learns to cope with the problemswhich have
  evolved over time and are handed down from one
  generation to the next. (Schein)
• Informally How we do things here
• What experienced staff know
• What new employees and clinicians learn
• What outsiders sense

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Defining a culture of patient safety

• Formally Stated values and underlying principles
  that guide those who work inside an organization
  to work safely.
• Informally How we do patient safety here
• Leadership attitude
• Reflection of training and resources
• What preventsor leads to patient harm

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Defining an optimal culture of patient safety

• Deliberate
• Well-articulated
• Universally understood

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Pursuing optimal patient safety

• Patient safety is
• more cultural than programmatic
• consistent for all of the patients interactions

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Understanding organizational culture

• An impression
• Stable, comfortable parameters for behavior
• A code of conduct
• A pattern of basic assumptions
• Revealed in a variety of ways

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Organizational culture

• An impression
• What you see
• What you hear
• What you feel

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Organizational culture

• Stable, comfortable parameters for behavior
• Whats expected
• Common foundation
• Always adjusting

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Organizational culture

• A code of conduct, for example
• Org. Culture 1 Thats not my job, go away.
• Org. Culture 2 Sorry, thats not my job, go
  see someone else.
• Org. Culture 3 Thats not my everyday job,
  but let me see how I can help you.

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Organizational culture

• A pattern of basic assumptions
• Suitable appearance
• Appropriate manners
• Cooperation
• Whos the boss, and whos not
• Institutional goals

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Organizational culture

• Revealed in a variety of ways
• What the customer patient sees
• What the customer patient hears
• What the customer patient feels

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Understanding an optimal culture of safety

• The right culture
• Built on underlying principles
• Expressed in stated values
• Demonstrated via visible signs

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Optimal culture of safety

• The right culture
• Sustained, thoughtful practice systemwide
• Individuals accept responsibility
• The safe way is the easy way

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Optimal culture of safety

• Underlying principles (what we really believe)
• Rule-based safety dictated via internal
  procedures and external regulators
• Goal-based safety targeted problems and outcomes
• Improvement-based safety a continuous assessment
  and improvement process

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Optimal culture of safety

• Stated values
• Expressed safety policies and procedures

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Optimal culture of safety

• Visible signs
• Observable safety components

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Why dont caring people act or think safely?

• Barriers
• Time
• Difficulty
• Discomfort
• Hassle

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Why dont caring people act or think safely?

• Rationalizations
• We havent experienced problems
• We like shortcuts
• Shortcuts usually dont lead to problems

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Pursuing an optimal culture of safety

• Assessment
• Improvement
• Perpetuation

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Assessing the culture of safety

• Determine the institutional characteristics
• Measure where the culture is now
• Compare current culture to the ideal
• Identify where improvements are needed

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Assessing the culture of safety

• Determine the institutional characteristics
• Patient perspective
• Caregiver perspective
• General environment

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Assessing the culture of safety

• Measure where the culture is now for
• Leadership
• Managers
• Staff
• Consumers

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Assessing the culture of safety

• Compare current safety culture to the ideal
• Overachieving
• Adequate
• Underachieving

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Assessing the culture of safety

• Identify where improvements are needed
• Determine available resources
• Be specific
• First things first
• Who needs to be involved

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Improving the culture of safety

• Secure commitments from key players
• Plan and implement improvements
• Communicate

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Improving the culture of safety

• Secure commitment from key players for
• Institutional commitment
• Funding
• Resources
• Follow through

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Improving the culture of safety

• Plan and implement improvements
• Work together
• Set goals
• Announce plans
• Monitor impact
• Capture the methodology

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Improving the culture of safety

• Communicate
• Ask
• Listen
• Plan
• Listen
• Act
• Listen

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Perpetuating an optimal culture of safety

• Signs of waning interest
• Drop off of leadership support
• New procedures/rules not followed/updated
• Unsafe conditions tolerated
• No individual taking responsibility
• Incidents not analyzed

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Perpetuating an optimal culture of safety

• Maintain leadership commitment
• Earmark resources
• Present business case
• Repeat the message

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Whose job is safety culture improvement?

• Senior staff
• Managers
• Caregivers

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Senior staff role in safety culture improvement

• Education and understanding
• Tension of accountability
• Interdisciplinary practice

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Senior staff role in safety culture improvement

• Education and understanding
• Educate yourself
• Assign responsibility
• Participate in patient safety rounds
• Conduct root cause analyses

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Senior staff role in safety culture improvement

• Tension of Accountability
• Who is accountable?
• Accountability vs. responsibility
• Respecting and supporting staff
• In the best interest of the public health

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Senior staff role in safety culture improvement

• Interdisciplinary practice
• Working hard, but not together
• Team makeup
• Team leadership
• Collaborating around patient care
• Shared responsibility

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Managers role in safety culture improvement

• Keep patient safety in the forefront
• Discuss it
• Encourage it
• Demonstrate it
• Evaluate it
• Train it
• Share it

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Managers role in safety culture improvement

• Design systems to prevent errors
• Simplify
• Computerize
• Discover
• Measure
• Engage
• Accept

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Caregivers role in safety culture improvement

• Voice opinions and concerns
• Suggest solutions as well as problems
• Report errors
• Take on a leadership role

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Caregivers role in safety culture improvement

• Voice opinions and concerns
• Be specific
• Address the appropriate individuals
• Look beyond blame

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Caregivers role in safety culture improvement

• Suggest solutions as well as problems

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Caregivers role in safety culture improvement

• Report errors
• Informally
• Formally

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Caregivers role in safety culture improvement

• Take on a leadership role
• In the absence of other initiatives
• Collaborating with existing activities
• Supporting colleagues

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Summary

• Every organization has multiple cultures
• Health care organizations have safety cultures
• Every HCO has safety culture barriers
• Achieving an optimal culture of safety requires
  assessment, improvement, and perpetuation
• Its everybodys job