Safety first: Building a culture that improves patient outcomes, reduces workplace errors

In recent years, “culture of safety” has become a popular catchphrase in healthcare, adopted by many providers to limit the inherent workplace risk factors of our industry. Understanding its origins and what it means, however, can help us create real change at our facilities, reduce the prevalence of workplace injuries and accidents, and produce the best outcomes for patients. The phrase was first popularized decades ago by the International Atomic Energy Agency, which attributed a “deficient safety culture” as the primary cause of the worst nuclear power plant accident in human history: the 1986 Chernobyl nuclear disaster. In its findings, the IAEA discovered that Chernobyl plant workers routinely disregarded protocol and did not challenge their supervisors – even if they knew they were wrong. As we know today, following protocol and reporting all safety violations are requirements for building a culture of safety, which is an organizational commitment acknowledging the inevitability of human error, proactively identifying threats and taking precautionary steps whenever possible. The U.S. Centers for Disease Control and Prevention defines a culture of safety as “the shared commitment of management and employees to ensure the safety of the work environment,” while the Agency for Healthcare Research and Quality (AHRQ) outlines the following criteria for any successful safety culture effort: “Acknowledgment of the high-risk nature of an organization’s activities and the determination to achieve consistently safe operations.” “A blame-free environment where 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 to address safety concerns.” In creating a safe work environment, AHRQ also highlights the importance of establishing a “just culture” among all employees. According to the organization, a just culture creates a fair environment that supports good employee decision making and establishes a zero tolerance policy for reckless behavior – which, in turn, supports individual accountability. A just culture “distinguishes between human error (e.g., slips), at-risk behavior (e.g., taking shortcuts), and reckless behavior (e.g., ignoring required safety steps), in contrast to an overarching ‘no-blame’ approach still favored by some,” the AHRQ recommends. “In a just culture, the response to an error or near miss is predicated on the type of behavior associated with the error, and not the severity of the event. For example, reckless behavior such as refusing to perform a ‘time-out’ prior to surgery would merit punitive action, even if patients were not harmed.” Another prerequisite for establishing a culture of safety is a commitment from the governing board and leadership team to support the efforts. Programs can fail before they even begin if managers and supervisors are not on board or have not received the appropriate training. Likewise, employees must know that leadership places a high premium on establishing a culture of safety. They also must know they’ll be supported in following these recommended steps for a safety-first culture: Assess current culture: In order to make improvements, you must first measure where you are. Assessing the current culture of safety is where you begin to make improvements. To learn where your organization stands, please visit www.ahrq.gov. Encourage teamwork –It’s everyone’s job to watch for failure. Members of effective teams understand both their individual roles as well as the collective responsibilities of the entire team. All team members are equal in a culture of safety. Team members need to feel comfortable speaking up or asking questions when they see something that concerns them. All team members must agree that being questioned by another team member is not because of a lack of trust or respect but directly related to patient safety. Involve patients-Include your patients in the process by encouraging them to ask questions when they see something that concerns or confuses them. Educate your patients with culture of safety brochures and posters, and pay attention to patient satisfaction surveys; patients see things from a very different perspective. Establish proven processes-By consistently taking the same steps you can reduce the risk of human error. Having a proven process in place gives the team guidelines to ensure things aren’t missed. A paper or verbal checklist is also a helpful tool. Include the clinical staff directly involved in the implementation and review of processes. They will know what will work best in real situations. Encourage transparency-Being open to the possibility of human error and feeling secure enough to be transparent when it comes to mistakes, near misses or identifying a process that could result in an error is crucial. All personnel should be clear on the expectations of transparency. Promote accountability-By promoting individual and organizational accountability, you send a powerful message about your center’s commitment to a culture of safety. It’s important for the team to believe accountability doesn’t mean assigning blame or pointing fingers. Instead, it means all personnel are aware of their responsibilities for maintaining a safe environment for the patients and one another. It also means when a failure is identified and reported, it will be reviewed by a quality committee or a designated group that will include clinical or front-line staff. Reassess regularly-Once your program is implemented, you’ll need to perform an annual culture of safety assessment to measure how the program is working. In particular, take time to learn from the near misses that occurred throughout the year. Providing the safest patient care possible is always the goal at Regent’s ambulatory surgery centers. Through continual commitment, singular focus, leadership support, training and a lot of hard work, we can lead by example and set the standard for our entire industry. For more information on how to put safety first at your ASC, please contact Kathleen Bernicky at kbernicky@regentsh.com.