Hospital Culture of Safety

Published by TDP on April 2, 2017

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Over a decade ago, the Institute of Medicine (IOM) urged health care organizations to adopt proven organizational models and strategies from other high-risk industries to minimize error and reduce harm to patients. To promote a culture of safety and ensure safer systems of care, the IOM emphasized the importance of developing clear, highly visible patient safety programs that focus organizational attention on safety; use non-punitive systems for reporting and analyzing errors; incorporate well-established safety principles such as standardized and simplified equipment, supplies, and work processes; and establish proven interdisciplinary team training programs for providers.

The IOM also noted that, “the biggest challenge to moving toward a safer health system is changing the culture from one 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”.

By developing a “systems” orientation to understanding and addressing medical errors, hospitals can foster an organization-wide continuous learning environment where members of the workforce feel comfortable reporting and discussing adverse events without fear of reprisal.

The Safety Culture of an organization is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization’s health and safety management.

In the healthcare environment there are many competing variables in the culture of an organization. The conflicting needs of patients, families, providers, institutions, regulators, etc. create many inconsistencies and mixed messages. In addition to the issues of hierarchy, there are “silos”, where each role or unit operates independently, without understanding the full implications of its actions on others. Key features of this program for a culture of safety include:

acknowledgment of the high-risk nature of a hospital’s activities and the determination to achieve consistently safe operations;
an environment in which individuals are able to report errors or near misses without fear of reprimand or punishment;
encouragement of collaboration across ranks and disciplines to seek solutions to patient safety problems;
organizational commitment of resources, such as staff time, education, a safe method for reporting issues, and the like, to address safety concerns.

SCOPE OF THE PROGRAM

This program covers elements from leadership commitment, just culture, systems reporting, teamwork, staff training and patient involvement. To implement an effective culture of safety program in a Hospital it entails continuous support and coordination from all levels of authority in the organization, continuous reporting of quality and safety incidents, continuous education about culture of safety and interdisciplinary communications and planning to address issues in the implementation of a safe culture.

GOALS OF THE PROGRAM

To establish a system that supports the culture of safety among different staff levels within the organization.
To encourage teamwork between hospital members and create program that allow positive culture of safety to flourish.
To establish a system that address undesirable behaviors of individuals working at all levels of the hospital, including management, clinical and administrative staff, licensed independent practitioners, and governing body members.
To identify and address issues related to systems that lead to unsafe behaviors.
To increase the level of awareness and encourage all staff to report issues concerning culture of safety.

OBJECTIVES OF THE PROGRAM

To educate all staff members on a regular basis about culture of safety.
To evaluate the hospital’s culture of safety on an annual basis using a variety of methods, such as formal surveys, focus groups, staff interviews, and data analysis.
To continuously analyze issues related to culture of safety and strategize timely investigations and resolutions to address the issue.
To report on a regular basis to hospital leaders all summary findings related to culture of safety.

Culture of Safety:

The U.K. Health and Safety Commission developed one of the most commonly used definitions of safety culture (adapted also by AHRQ- Agency for Healthcare Research &Quality): “The product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization’s health and safety management.” Organizations with positive safety culture are characterized by communications founded on mutual trust, by shared perceptions of the importance of safety and by confidence in the efficacy of preventive measures.