Creating a culture of safety - Patient Safety First

AORN Journal,  July, 2002  by Suzanne C. Beyea

• E-mail
• Print
• Link

Many practitioners have asked "How do I start a patient safety program in my facility?" There is no single solution that is right for everyone; however, some basic principles and approaches can help all clinicians and managers in their efforts to promote safety. A critical first step in developing any safety program is the establishment of a culture of safety and trust in a specific clinical department and facility.

   The biggest challenge in moving toward a safer health system is changing
   the culture of one of blaming individuals for errors to one in which errors
   are treated not as personal failures, but as opportunities to improve the
   system and prevent harm. (2)

SAFETY IN INDUSTRY

Success of a safety program depends on creating a commitment by all stakeholders to build and support a culture of safety and addressing system failures. Researchers have found that when large-scale industrial disasters occur, the system failures relate to diffused responsibilities, neglect of the severity of the risks, lack of sharing and learning from others, performance goals taking priority over safety, poorly defined responsibility for safety in the organization, persistent flawed design features, not using risk management techniques, team members' inability to voice concerns, and a belief that compliance with the rules ensures safety. (3)

Furthermore, major industries have used data from errors and near misses and a systems approach to minimize the number and severity of accidents. Their strategies have included a nonpunitive reporting system free of disciplinary measures for accidents and near misses, a consistent commitment to safe practices, an effective error-tracking system, high levels of redundancy in processes, and high-level organizational learning. (4)

ESTABLISHING A SAFETY PROGRAM

To effectively establish a patient safety program and create a culture of safety, all employees must "detect and tell us about unsafe situations and systems as part of their daily work." (5) A culture of safety focuses on four fundamental elements:

* developing a sense of trust among all stakeholders and caregivers in the clinical setting,

* disseminating information to all levels of managers and employees and ensuring that the message is communicated,

* developing and supporting a proactive approach instead of a reactive response, and

* ensuring a sincere commitment to a culture that places safety as the first priority.

Such a culture of safety cannot only be espoused; it must be a lived experience and integral to every clinical activity and decision. Safety must be the driving force for decision making and serve as a precondition and the first priority for both patients and caregivers.

A culture of safety requires that staff members trust each other and feel that they are valued and supported. Trust can be diminished by environments in which managers blame employees and do not address system failures or near misses when they occur. Each team member must feel safe to voice concerns and be empowered to intervene if safety hazards exist. Furthermore, every staff member must be encouraged to fully participate in activities that promote patient safety.

Highly functioning teams also can be helpful in reducing the number of actual and potential errors. One researcher reports that four characteristics are helpful in improving patient care and reducing errors. These include

* thoroughness and attention to detail,

* effective teamwork on all levels,

* listening to every member of the clinical team, and

* listening to all caregivers, relatives, and patients. (6)

Highly effective teams can be supported by improving decision making, listening to patients, rewarding teams, encouraging innovative solutions, ensuring accountability and autonomy, and providing leadership. (7)

Developing teams that are willing to learn and work together is a critical responsibility of leaders and a cornerstone of any patient safety program.

The Institute of Medicine's 2000 report To Err is Human: Building a Safer Health System states that a

   meaningful safety program should include senior-level leadership, defined
   program objectives, plans, personnel, and budget, and should be monitored
   by regular progress reports to the executive committee and board of
   directors. (8)

This level of commitment and the creation of a nonpunitive environment supports processes by which safety becomes integral to clinical systems. The ability to collect data on all errors and near misses promotes a department's or facility's ability to use the data to identify improvement opportunities and monitor results.

AN EXAMPLE

The US Department of Veterans Affairs (VA) has taken a number of steps to promote a culture of safety in its organizations. A cornerstone of its patient safety efforts has been a public commitment by leaders to address system failures and establish a culture of safety. The VA has taken action on all of the recommendations made by the National Patient Safety Partnership. In follow-up to these initiatives, the VA developed the National Center for Patient Safety and four patient safety centers of inquiry that each research a different aspect of patient safety and identify problems in patient care processes and improvement strategies.