Building and maintaining a culture of safety has become a key part of a patient safety program. Since the Institute of Medicine's To Err is Human was published 10 years ago, the healthcare industry has made a concerted effort to focus more energy on creating systems by which patients are kept more safe, and staff members are set up to succeed.
This year's Briefings on Patient Safety Culture of Safety Survey results show that while the overwhelming majority of hospitals are addressing their cultures of safety, there are certain areas to which more attention could be paid in the future.
More than 900 patient safety professionals answered the survey questions, most of whom (84%) worked at hospitals. When asked if they thought their facilities had strong cultures of safety, 41% said yes, and 57% said "We are working toward improving our culture of safety." This is encouraging, although perhaps suggests that healthcare as an industry may not have one "strong" culture of safety definition.
"I think that's a very positive thing, but I think the healthcare industry really needs to be careful of not becoming overconfident and complacent," says Ken Rohde, senior consultant for The Greeley Company, a division of HCPro Inc. "What the healthcare industry considers a strong culture of safety might be actually relatively weak compared to aviation or nuclear power or other high risk industries. If everybody thinks they're getting an A in healthcare, that might only be a C- in the rest of high-risk industries."
Another question on the survey asked respondents to evaluate what has caused (if any) an increase in the attention paid to creating and maintaining a culture of safety. The majority of respondents said that their hospital was motivated by external agencies.
Twenty-five percent said motivation came from increased requirements from accrediting bodies (The Joint Commission) and 34% said motivation came from large patient safety groups (IHI, National Quality Forum). Twenty-seven percent answered "It's just the right thing to do," 4% said a near miss or medical error had caused the facility to pay more attention to culture of safety, 1% listed an increased financial incentive, and 8% gave other reasons.
"We need to make sure we're getting away from being externally driven, because as soon as somebody backs off, the Joint Commission isn't pushing us, then people will slide right back to where they used to be," says Rohde. He also says he hopes that that next time the survey is conducted, more respondents answer with "it's just the right thing to do."
One other point that this question brings up about building a culture of safety is the role that error reporting plays. Though it may not be a bad thing that only 4% of respondents attributed the occurrence of near misses or medical errors to why the culture of safety has been given more attention, it does open up the possibility that many hospitals do not have comprehensive error reporting systems in place.
"A hallmark of a strong safety culture is that it is a reporting culture," says Mary Voutt-Gous, RN, BSN, CCRN, director of patient safety initiatives for Henry Ford Health System in Detroit, MI. "That helps us identify weaknesses and prevent errors. High reliability organizations do that."
Voutt-Goos suggests that facilities step back and evaluate how their error reporting is used. If it's used as a weapon, it's likely that most staff members will not report when an error or near miss has occurred. Although most staff members would answer on a survey "yes, I'd speak up if I committed an error," most staff members can also identify scenarios in which it might be difficult to speak up when asked personally. Leadership actions can precipitate the environment that exists within a hospital.
"There's a disconnect between what they know is right to do, and what they're comfortable doing in specific environments," says Voutt-Goos. It is imperative that managers find out where those weak spots are and focus on building trust between leaders and front-line caregivers. Though staff members usually have patient care at the core of their daily jobs, there's definite concern about their own personal reputation and future at the facility.
"When you speak up, that can be viewed as a troublemaker, and that can impact your career," says Voutt-Goos. She suggests that hospitals make the act of speaking up and reporting errors less personal and create consistent policies about how those types of situations will be handled.