evidence-based strategies to advance a safety culture in ...safety culture in child welfare a safety...

Evidence-based Strategies to Advance a Safety Culture in Child Welfare

Safety Culture in Child Welfare

A safety culture is one in which organizational values, attitudes, and behaviors support an engaged workforce and reliable care delivery.

Leaders in a safety culture:– Strive to balance systems and individual accountability; and– Value open communication, transparency, and continuous learning

and improvement.

Teams in a safety culture– Monitor themselves, their colleagues, and their system for stress– Anticipate and respond to unexpected events

Cull, Rzepnicki, O’Day, & Epstein (2013)

Serenity Deal3

Choice?

ECONOMIC CONSTRAINTS

OPERATIONAL CONSTRAINTS

Budget Cuts

Limited Resources

Service Array

High Caseloads

Turnover Paperwork

Work as Prescribed

SAFE WORKBOUNDARY

Erro

r M

argi

n

Failure Point

Safety Culture

Cook & Rasmussen (2005)

Enhanced surveillance

Reliable systems

Better communication

Culture Carriers

Measuring Our Safety Culture

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2013 2015

pe

rce

nt

po

siti

ve r

esp

on

se o

n 7

po

int

scal

e

Psychological Safety

Burnout

Safety Organizing

Stress Recognition

Year to Year Comparison – All Regions, All Staff

(n=1719) (n=1431)

0

10

20

30

40

50

60

70

80

90

100

Aviation Healthcare Child Welfare

pe

rce

nt

po

siti

ve r

esp

on

se

Stress Recognition Across Industries12

(Gaba et. al., 2003)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Stress Recognition Burnout Safety Organizing Psychological Safety

Larimer – TN Safety Culture Survey Comparison

Larimer Cnty Knox Cnty Tenn Statewide

Pe

rce

nt

Po

siti

ve R

esp

on

se

Three Levels of Stress Response

PositiveBrief increases in heart rate.

Mild elevations in stress hormone levels

TolerableSerious, temporary stress responses,

Buffered by supportive relationships.

ToxicProlonged activation of stress response systems

In the absence of protective relationships.

Harvard Center of the Developing Child

Interplay of Stress and Fatigue

16

Walker et. al., Current Biology, October 2014

"The emotional centers of the brain were over 60 percent more reactive under conditions of sleep deprivation than in subjects who had obtained a normal night of sleep,"

Debriefings348 Conducted625 Findings

0

20

40

60

80

100

120

CDR-2013 Systems Analysis

Do

cum

en

ted

Fin

din

gs

CDR 2013 Systems Analysis 2014

34

31

29

26 26

24

21

18

15

12

9

6

Freq

uen

cy o

f Sy

stem

ic F

ind

ing*

CY 2015 Child Death Review Systemic Findings

0 2 4 6 8 10 12 14 16 18

System Change

2014 Rate 2015 Rate

-29%

-5%

-10%

-40%

-5%

-49%Equipment/Technology

Stress

Demand-Resource Mismatch

Medical Records

Knowledge Deficits

Teamwork/Coordination

Enhanced surveillance

Reliable systems

Better communication

Predicting Problematic Prescribing Behavior

Thank you…