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People Based Patient Safety

2013 SC Patient Safety Symposium

Josh Williams, Ph.D. Safety Performance Solutions

610 N. Main Street, Suite 228 Blacksburg, VA 24060

www.safetyperformance.com

(540) 951-1032

[email protected]

2

Common Themes

in an Ideal Safety Culture.

Senior managers invest sufficient money and resources to

ensure a safe work environment.

Safety is not compromised when determining schedules,

overtime, and staffing.

Senior managers spend time talking one-on-one with

employees about safety.

Supervisors don’t put time pressure/production ahead of

safety.

Supervisors praise employees for working safely.

3

Common Themes

in an Ideal Safety Culture.

Supervisors caution employees respectfully for risky

behaviors (improper lifting with patient transfer, bed rails

not in place, trip hazards on floor, medication storage).

Employees caution each other about at-risk behaviors and

do so respectfully and employees appreciate safety

feedback from others.

Employees don’t take safety shortcuts.

Employees work safely when supervisors aren’t around.

4

Exercise: Define An Ideal Safety Culture.

List characteristics of an ideal safety culture. Be sure to consider specific behaviors and

attitudes of people, as well as the environment.

© 2005 Safety Performance Solutions, Inc. (05.05) 5

A Total Safety Culture Requires a Shift

from Dependence to Interdependence

Improving Safety Behavior

©Safety Performance Solutions, Inc. (1.08) 7

SAFETY

CULTURE

Focus on 3 Areas to Improve

Safety Culture.

ENVIRONMENT

Equipment, Tools, Machines,

Housekeeping, Climate,

Management Systems

BEHAVIOR

Putting on PPE, Lifting properly, Following procedures,

Locking out power, Cleaning up spills,

Sweeping floors, Coaching peers

PERSON

Knowledge, Skills, Abilities,

Intelligence, Motives,

Attitude, Personality

BEHAVIOR

Putting on PPE, Lifting properly, Following procedures,

Locking out power, Cleaning up spills,

Sweeping floors, Coaching peers

8

At-Risk Behavior

Contributes to Most Injuries.

Inju

ry

9

0

20

40

60

80

100

Values

(Should)

Intentions

(Willing)

Behaviors

(Do)

Perc

ent A

gre

em

ent

...caution coworkers when observing

them perform at-risk behaviors.”





Our Actions Don’t Always Match Our Values.

“I do ... “I am willing to ... “Employees should ...

90% 85%

60%

From more than 100,000 survey responses, people said…

Goal


Sometimes the “System” Motivates the

Wrong Behavior.


Reasons Why We Take Risks

Bad Habit

Peer Pressure

Lack of Accountability

Time Pressure

Poor Communication

Poor Ergonomic Job Design

Confusing Procedures

Inadequate Training

Low Expectations Set by Supervisor


Unsafe Behavior is Often

the Result of System Influences.

No

At-Risk Behavior

Yes

Did operator purposefully perform

a behavior which

s/he knew to be unsafe?

Human Error Calculated Risk

Individual

Variance System-Induced

Human Error

System-Encouraged

Behavior

Willful Negligence

Act of sabotage


The ABC Model

Explains Why We Do What We Do.

Activators

Consequences

Behavior Motivate

Direct


Activators and

Consequences Take Many Forms

Activators: Safety Meetings, Goal setting, Rules and Regulations, Policies and Procedures,

Incentives/Disincentives, Instructions, Signs, Training, Modeling, Saying please

Behaviors: Patient transfer (lifting), hand washing, storing medication, pinch points with

wheelchairs, hairnets, jewelry, verbal confirmation with patients, bed rails in place,

dry floors

Consequences: Self-approval, Reprimand, Peer approval, Penalty, Feedback, Injury, Prize or

trinket, Inconvenience, Thank-you, Time savings, Comfort


Some Tasks Have Natural

Rewarding Consequences.


Safe Behaviors Often Lack

Natural Rewarding Consequences.


Safety Is a Continuous

Fight with Human Nature.

At-risk behaviors are often more comfortable, convenient, and faster

than safe behaviors.

At-risk behaviors are often reinforced by the work culture.

At-risk behaviors rarely result in negative consequences (e.g., injury,

reprimand) powerful enough to discourage their performance.

Initial safety awareness and carefulness is often short-lived because

of a natural learning process called drift.


How Should We Motivate Safety?

Improving Management Practices

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Management Approval is an

Especially Powerful Motivator.

People tend to “obey”

authority.

Managers control or influence

many consequences.

Pay

Promotion

Discipline

“What’s Important to the Manager

is Important to the Employee.”

21

Without Care, Leaders May

Reinforce At-Risk Behaviors.

A. Fail to reinforce a safe behavior

B. Fail to coach an at-risk behavior

C. Reinforce competing behaviors

D. Model at-risk behaviors

22

A. Why Would Leaders Not

Reinforce Safe Behavior?

“It’s their job.”

Too busy

Don’t notice safe behaviors.

They think it’s a waste of time.

Without Reinforcing Consequences, Desirable

Behaviors May Stop.

23

B. Why Would Leaders Not

Coach At-Risk Behavior?

It’s uncomfortable confronting others.

Production demands

Don’t believe the behavior will change anyway.

It’s not seen as a big deal.

Don’t want to look foolish or don’t know the job that well.

Failure to Coach Undesirable Behavior Implies

Acceptance.

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C. Why Would Leaders Focus

on Productivity Over Safety?

Greater organizational pressure for production vs. safety.

Production = Direct responsibility of leaders.

Leaders are held accountable for production.

Production is easily measured.

Focusing on Only on Production Demonstrates A Higher Priority Than Safety.

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D. Why Would Leaders

Model At-Risk Behavior?

Don’t know better

Risky habits

Don’t think anyone will notice.

Don’t have the same exposure level as employees

Modeling risky behaviors undermines safety credibility.

26

D. Leaders Need to “Walk the Talk.”

27

Be Careful with Modeling.

Communication Skills

© 2005 Safety Performance Solutions, Inc. (05.05)

31

Several Communication Styles

Impact Safety Feedback.

Sheriff- Direct and task oriented

Diplomat- Supportive and inclusive of others

Investigator- Accurate and detail oriented

Most individuals have various levels of all three styles depending on the situation.

Adapted from Poertner & Miller, 1996


32

Sheriffs Have Certain Attributes.

Strengths

Direct

Practical

Big Picture

Task-oriented

Closure-oriented

Weaknesses

Impatient

Overly independent

Combative

Insensitive

Domineering


33

Diplomat Have Certain Attributes.

Strengths

Supportive

Patient

Consistent

Actively listens

Responsive

Weaknesses

Avoids confrontation

Passive and indecisive

Slow to change

Slow to initiate ideas

Withholds feelings


34

Investigators Have Certain Attributes.

Strengths

Accurate

Well prepared

Analytical

Systematic

Detail oriented

Weaknesses

Loses forest for trees

Inflexible

Micromanaging

Overly cautious

Unrealistic standards


35

Loses forest for trees,

Inflexible, Micromanaging,

Overly cautious, Unrealistic

standards

Impatient, Overly

independent, Combative,

Insensitive, Domineering

Each Communication Style Has

Unique Strengths and Weaknesses.

Style Strengths Weaknesses

Sheriff

Diplomat

Investigator

Direct, Practical,Big

Picture Focus, Task-

oriented, Closure-oriented

Supportive, Patient, Easy-

going, Consistent, Actively

listens, responsive to others

Accurate, Well-prepared,

Analytical, Systematic,

Detail-oriented

Avoids confrontation, Passive

and indecisive, Slow to change,

Slow to initiate ideas,

Withholds true feelings


36

DIRECTIONS: Consider your own communication patterns. Rate yourself from 1 to 10 in terms of how strongly you fit each category. Higher scores represent a stronger fit for that category. For instance, you may be a “2” for Sheriff, “10” for Diplomat, and “5” for Investigator. Do not give any two categories the same rating number. Do not share your self-assessment with others.

After everyone has written down their own ratings, various group members will be selected for others to rate their communication styles. Do we rate ourselves the same way others rate our communication style?

Rating of Rating of Rating of Rating of Self Another Another Another

Sheriff

Diplomat

Investigator

Exercise: Determine Your Level of

Each Communication Style.


37

Effective Communicators

Appreciate Diverse Styles.

Recognize the strengths and limitations of all three

communication styles.

Be flexible in your preferred communication style.

Different situations may require different styles.

Develop a more holistic communication style.

Accept diverse communication styles in others.


38

General Communication Guidelines

Show respect for others’ opinions. Thank others for their input.

Ask questions to facilitate discussions (vs. constant lectures).

Share information about yourself to maintain rapport.

Ask others about themselves and how they are doing.

Be sincere and genuine.


39

General Communication

Guidelines, Cont.

Use appropriate, tasteful humor.

Speak constructively and positively.

Confront problems as soon as they occur.

Don’t let negative feelings build up.

Express opinions directly and honestly.


40

Follow These Guidelines

When Giving Recognition for Safety.

Give it one-on-one.

Be SINCERE.

Don’t always follow up with corrective feedback.

Nice job, but….

Give praise and recognition more often.


41

Recognition Matters.


42

Follow These Guidelines

When Giving Correcting Feedback.

Give it one-on-one, immediately, and focus on

behavior.

Show concern for others’ feelings and well being.

Give the receiver a chance to respond.

Discuss alternate methods together. Don’t nag.


43

Guidelines For Receiving Correcting Feedback

Be objective, not defensive.

Avoid unnecessary arguments.

Accept feedback without anger.

Thank the person for trying to help.


44

Levels of Listening

1. Ignoring

2. Pretending

3. Selective

4. Active

5. Empathic


45

Choose Your Words Carefully.

Use ‘I’ statements.

State your opinions as opinions, not facts.

Use safe and at-risk instead of right and wrong.

Use at-risk instead of unsafe.

Avoid using absolutes such as must, never, and always.

Avoid labeling person factors; focus on the behavior.

Use corrective instead of negative feedback. Talk about areas

of concern, or opportunities for injuries.


46

Additional Communication Skills

Active Listening

Don’t interrupt

Ask open-ended questions to clarify meaning

Paraphrase but don’t parrot

Non-Verbal Communication

Eye contact

Personal space

Vocal tone


47

There are Various

Communication Patterns.

1. Dominant

2. Passive

3. Passive-Aggressive

4. Empathic

The empathic communication pattern is most effective. Other patterns are ineffective and can damage organizational culture.


48

Dominant Communicators

Thoughts “Others should think the way I do.”

“I am seldom if ever wrong.”

“People who disagree with me are either disloyal or misinformed.”

Behaviors Publicly criticizes others.

Blames others when problems arise.

Bossy, bullying, and negative.

Fails to show appreciation for others’ accomplishments.

Frequently interrupts others, finishes others’ sentences.

Dismisses new ideas without hearing the rationale first.


49

Passive Communicators

Thoughts “Don't express your true feelings.”

“Don't make waves.”

“Don't disagree with others.”

Behaviors Remains quiet even when disagreeing or being treated unfairly.

Asks permission unnecessarily.

Spends too much time avoiding conflict.

Tends to be overly self-critical and overly agreeable.


50

Passive-Aggressive Communicators

Thoughts “When you have an issue with someone, go behind their back.”

“Build coalitions against others instead of dealing with people directly and

honestly.”

“Get back at others if they cross you, even if it takes a while.”

Behaviors Appears to agree with others when they really don’t.

Expresses concerns about an individual to other people instead of that person

directly.

Holds grudges and values “getting even.”

Frequently gossips.


51

Empathic Communicators

Thoughts “Personal opinions and the opinions of others are important.”

“The process of coming to a decision (not just the decision itself) is important.”

“Getting input from others boosts morale and generally leads to better decision

making.”

Behaviors Communicates using choices instead of demands.

Tends to be proactive, assertive, and action-oriented.

Tends to be realistic in expectations.

Communicates in a direct, honest manner.

Works to achieve goals without compromising others.


52

Most of the Message We Send To Others Is Through

Body Language and Vocal Patterns (Voice).

55%38%

7%

Body Language

Voice

Words

- Albert Mehrabian


53

Identify These Emotions as Conveyed Through

Body Language and Facial Expressions


54




55




56




57

Follow These Guidelines to Improve Body

Language and Vocal Patterns.

Smile sincerely.

Don’t fidget.

Maintain eye-contact.

Watch vocal volume.

Loud volume reflects aggression.

Soft volume reflects weakness.

Watch pace of speaking.


58

Here are Guidelines for Communicating with

Difficult People.

Don’t take it personally.

Keep your cool.

Exchange information not emotion.

Let them know you understand the message but don’t

appreciate the delivery.

Don’t lose sleep over it. They don’t suffer when you are

upset, you do.


59

Follow These Guidelines When

Communicating Through Email. Use verbal feedback, not email, for sensitive issues.

Keep the language constructive and focused on problem solving.

Be as concise and direct. (Also important with voice mail.)

Watch for spelling errors.

Avoiding bombarding people with an excessive number of emails at a given time (especially in companies with slow servers).

Respond to emails as quickly as possible.

Don’t use ALL CAPS or colors.


60

Exercise: Key Aspects of

Communication

List the key aspects of effective communication.

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