fostering a culture of safety in a health care environment
TRANSCRIPT
Fostering a Culture of Safety in a Fostering a Culture of Safety in a Health Care EnvironmentHealth Care Environment
Presentation OutlinePresentation Outline
Culture of Safety for Health Care WorkersCulture of Safety for Health Care Workers How to Create a Culture of Safety in a How to Create a Culture of Safety in a
Health Care EnvironmentHealth Care Environment Providing and Maintaining Safe Patient Providing and Maintaining Safe Patient
Care EnvironmentsCare Environments Knowledge Transfer Knowledge Transfer Staff Buy-In & Management/Leadership Staff Buy-In & Management/Leadership
SupportSupport
What Do Effective Safety Cultures Have in Common?
What Do Effective Safety Cultures Have in Common?
Corporate Culture demonstrates a Corporate Culture demonstrates a constant constant commitment to safety as a commitment to safety as a top-level priority.top-level priority.
This attitude permeates the entire This attitude permeates the entire organization.organization.
There are common components….There are common components….
What Do Effective Safety Cultures Have in Common?
What Do Effective Safety Cultures Have in Common?
Common Components Common Components AcknowledgementAcknowledgement of the high risk, error-prone of the high risk, error-prone
nature of the organization’s activitiesnature of the organization’s activities Blame-freeBlame-free environment – employees can report environment – employees can report
errors or close calls w/out punishmenterrors or close calls w/out punishment Expectations Expectations of of collaborationcollaboration across ranks to across ranks to
seek solutions to vulnerabilitiesseek solutions to vulnerabilities WillingnessWillingness on the part of the organization to on the part of the organization to
direct direct resourcesresources to address safety concerns to address safety concerns Provision of Provision of a Safea Safe Work EnvironmentWork Environment
What is ‘Culture’?What is ‘Culture’?
““Culture is patterns of behavior that are Culture is patterns of behavior that are acquired and transmitted by symbols acquired and transmitted by symbols created by humans, including their created by humans, including their
embodiments in artifacts. embodiments in artifacts.
The essential core of culture consists of The essential core of culture consists of traditional ideas and their attached values.traditional ideas and their attached values.
(Kroeber & Kluckhorn, 1952)(Kroeber & Kluckhorn, 1952)
Language
Culture is...Culture is...
LearnedLearned SharedShared Contains multiple facets Contains multiple facets
Artifacts
Social Interaction
Material Life
Knowledge Transfer Mechanisms
Values
The Culture of Safetyfor Health Care Workers The Culture of Safetyfor Health Care Workers
LanguageLanguage:: The way our culture is described.The way our culture is described.
Injury/accident vs Safety and Injury/accident vs Safety and Minimizing RiskMinimizing Risk
ArtifactsArtifacts:: Equipment/Technology used Equipment/Technology used
Outdated lifting equipment vs Outdated lifting equipment vs state-of-the art equipmentstate-of-the art equipment
The Culture of Safetyfor Health Care WorkersThe Culture of Safetyfor Health Care Workers
SocialSocial interactioninteraction:: How members interact. How members interact.
Top down approach vs employeeTop down approach vs employeeempowermentempowerment
CCaring for patients according to safety aring for patients according to safety guidelines vs co-workers guided by a collective guidelines vs co-workers guided by a collective and joint belief in the importance of safety, and joint belief in the importance of safety, with the shared understanding that every with the shared understanding that every member upholds the group's safety normsmember upholds the group's safety norms
ValuesValues:: Productivity vs maintaining a Productivity vs maintaining a safe environment of caresafe environment of care
Material LifeMaterial Life:: Procurement of Procurement of equipment by purchasing equipment by purchasing department vs active department vs active involvement of front line involvement of front line workers in choice of equipmentworkers in choice of equipment
The Culture of Safetyfor Health Care Workers
The Culture of Safetyfor Health Care WorkersThe Culture of Safetyfor Health Care Workers
Knowledge Transfer:Knowledge Transfer:
The sharing of The sharing of common knowledge - common knowledge - what what we learn in doing our work (Dixon 2000). we learn in doing our work (Dixon 2000).
Following procedures and policies vs Following procedures and policies vs utilizing employees’ knowledge of their jobsutilizing employees’ knowledge of their jobs
What differences What differences are seen in a are seen in a Culture Culture
of Safetyof Safety and a and a Culture of BlameCulture of Blame??
The Culture of Safetyfor Health Care Workers
Blame and Gain Behaviors*Blame and Gain Behaviors*
JudgingJudging vsvs ExploringExploring
Showing emotion Showing emotion vsvs Remaining calmRemaining calm
Reacting to what Reacting to what vs vs Finding out exactly Finding out exactly you think happenedyou think happened what happenedwhat happened
Blaming people forBlaming people for vsvs Focusing on the processFocusing on the processgetting it wronggetting it wrong that allowed mistake tothat allowed mistake to
happenhappen
*Pearn, Mulrooney & Payne, 1998
Blame and Gain Behaviors*Blame and Gain Behaviors*
Finding faultFinding fault vsvs Proving supportProving support
Focusing on effects Focusing on effects vsvs Focusing on causesFocusing on causes
Assuming the person Assuming the person vs vs Assuming the person Assuming the person should feel guiltyshould feel guilty wants to learnwants to learn
Seeing mistakes asSeeing mistakes as vsvs Seeing mistakes asSeeing mistakes assomething that mustsomething that must part of a learning part of a learning be avoided be avoided processprocess
*Pearn, Mulrooney & Payne, 1998
“Gain (Safety) Cultures”“Gain (Safety) Cultures”
People learn from their mistakesPeople learn from their mistakes People avoid making the same kind of People avoid making the same kind of
mistakes by sharing the lessons learnedmistakes by sharing the lessons learned When mistakes occur people take When mistakes occur people take
responsibility for them responsibility for them
Sitkin, 1992
If the last words of your employee, before reporting to Employee Health were, “Hey guys, watch this!”, you probably do not have the safety culture you want.
How to Create a Culture of Safety in a Health Care EnvironmentHow to Create a Culture of Safety in a Health Care Environment
Management/Leadership Support
Knowledge Transfer Mechanisms
Safe Patient Care Environment
Staff Buy-In/Support
Provide/Maintain a Safe Patient Care Environment
Nursing is a High Risk Nursing is a High Risk Occupation…Occupation…
You CANNOT have a Culture of You CANNOT have a Culture of Safety without Control Safety without Control
Measures in place to reduce Measures in place to reduce risk for Nursing Staffrisk for Nursing Staff
Unsuccessful SolutionsUnsuccessful Solutions
Over the past 30 years, Over the past 30 years, efforts to reduce injuries efforts to reduce injuries have been largely have been largely unsuccessfulunsuccessful
Interventions have Interventions have focused on focused on body mechanics educationbody mechanics education training in lifting
techniques
Culture of Safety concept was unknown/ignored
Successful SolutionsSuccessful Solutions
VISN-Wide Deployment of a VISN-Wide Deployment of a Back Injury Prevention Back Injury Prevention
Program for Nurses: Safe Program for Nurses: Safe Patient Handling and Patient Handling and
MovementMovement
Safe Patient Handling & Movement ProgramSafe Patient Handling & Movement Program
Uses Uses Patient Care ErgonomicsPatient Care Ergonomics to select to select appropriateappropriate Patient Handling Equipment Patient Handling Equipment
Includes Includes continualcontinual Environmental HazardEnvironmental Hazard EvaluationEvaluation
Includes Program & Equipment Includes Program & Equipment Support Support StructuresStructures SPHM TeamSPHM Team Peer LeadersPeer Leaders SPHM Policy SPHM Policy Knowledge Transfer MechanismsKnowledge Transfer Mechanisms
Safe Patient Handling & Movement ProgramSafe Patient Handling & Movement Program
Knowledge Transfer MechanismsKnowledge Transfer Mechanisms Mechanisms to Mechanisms to obtainobtain AND AND supplysupply informationinformation
After Action ReviewAfter Action Review Unit Peer Leaders (Back Injury Unit Peer Leaders (Back Injury Resource Nurses)Resource Nurses)
Assessment, Algorithms, & Care Assessment, Algorithms, & Care Plan for Safe Patient Handling & Plan for Safe Patient Handling & MovementMovement
How to Create a Culture of Safety in a Health Care EnvironmentHow to Create a Culture of Safety in a Health Care Environment
Management/Leadership Support
Knowledge Transfer Mechanisms
Safe Patient Care Environment
Staff Buy-In/Support
Culture of SafetyCulture of Safety
Knowledge TransferKnowledge Transfer… …
fosters a Culture of Safetyfosters a Culture of Safety
Knowledge TransferKnowledge Transfer
Knowledge transfer is the sharing of Knowledge transfer is the sharing of common knowledge. common knowledge.
CommonCommon knowledge is what we learn in knowledge is what we learn in doing our work (Dixon 2000). doing our work (Dixon 2000).
Common knowledge can be either tacit Common knowledge can be either tacit (i.e. residing in people’s heads) or explicit (i.e. residing in people’s heads) or explicit (i.e. can be written down into a series of (i.e. can be written down into a series of steps or guidelines).steps or guidelines).
Mechanisms of Knowledge Transfer Mechanisms of Knowledge Transfer
Learning BeforeLearning Before• Peer Leaders Peer Leaders
(BIRNS)(BIRNS)• Failure Mode & Failure Mode &
Effect Analysis Effect Analysis (FMEA)(FMEA)
• Best PracticesBest Practices• AARAAR
Learning AfterLearning After• Accident Accident
Review Boards Review Boards (ARB)(ARB)
• Root Cause Root Cause Analysis (RCA)Analysis (RCA)
• Safety Safety Investigations Investigations (OSHA)(OSHA)
• Educational Educational OutreachOutreach
• Best Practices Best Practices SystemsSystems
• EpidemiologyEpidemiology• After Action After Action
Review (AAR)Review (AAR)
Learning DuringLearning During• Individual Individual
ImprintingImprinting• Personal Personal
ExperienceExperience
Human ActionHuman Action
Knowledge Transfer…Knowledge Transfer…
Fosters a Culture of Safety Solves problems quickly Facilitates implementation of best
practices effectively and efficiently Empowers staff by using the knowledge
they possess
How to Create a Culture of Safety in a Health Care EnvironmentHow to Create a Culture of Safety in a Health Care Environment
Management/Leadership Support
Knowledge Transfer Mechanisms
Safe Patient Care Environment
Staff Buy-In/Support
How to Create a Culture of Safety in a Health Care EnvironmentHow to Create a Culture of Safety in a Health Care Environment
How can your organization achieve...
• Staff Buy-In/Support?
• Management/Leadership Support?
How to Create a Culture of Safety in a Health Care EnvironmentHow to Create a Culture of Safety in a Health Care Environment
Utilize Change StrategiesUtilize Change Strategies Use Social MarketingUse Social Marketing Involve Front-line WorkersInvolve Front-line Workers Ensure Staff are Competent in Use of Ensure Staff are Competent in Use of
Program Elements & EquipmentProgram Elements & Equipment Use Unit Peer LeadersUse Unit Peer Leaders Develop Action PlansDevelop Action Plans
How to Create a Culture of Safety in a Health Care EnvironmentHow to Create a Culture of Safety in a Health Care Environment
KNOW…
You can never implement change so well that some employees will not be distressed.
BUT…
You can implement change so poorly that virtually all employees will be distressed!!
Social Marketing in Health CareSocial Marketing in Health Care
Distressed, yes, but remember…Distressed, yes, but remember…
There is no such thing as There is no such thing as RESISTANCE – RESISTANCE –
only REACTIONS to change!only REACTIONS to change!
Social Marketing in Health CareSocial Marketing in Health Care
What is the response when a behavior is What is the response when a behavior is viewed as being ‘resistant’ to change?viewed as being ‘resistant’ to change?Listen lessListen lessEmotions escalateEmotions escalateBlame the personBlame the person
Social Marketing in Health CareSocial Marketing in Health Care
What is the response when the behavior is What is the response when the behavior is viewed as ‘reactions’ to change?viewed as ‘reactions’ to change?Listen moreListen moreEmotions diminishEmotions diminishProblem solveProblem solve
How to Create a Culture of Safety in a Health Care EnvironmentHow to Create a Culture of Safety in a Health Care Environment
What are the responsibilities/roles of
Management and Staff in facilitating a Culture of
Safety?
Responsibilities of Front Line StaffResponsibilities of Front Line Staff
Accept leaders’ invitations “to play”Accept leaders’ invitations “to play” Learn about and practice ‘systems Learn about and practice ‘systems
thinking’thinking’ Team with management Team with management Team with co-workersTeam with co-workers Commit to improving communication Commit to improving communication
across organizational levels, units, and across organizational levels, units, and among peer groupamong peer group
Role of Leaders & ManagersRole of Leaders & Managers
Demonstration of a Demonstration of a constant constant commitment to safety as a top-level commitment to safety as a top-level priority.priority.
Facilitating the permeation of this Facilitating the permeation of this attitude through the entire attitude through the entire organization.organization.
Know…..Know…..
A “Culture of Safety” A “Culture of Safety” is Attainable…is Attainable…
