Safety culture is a facet of organizational culture that captures attitudes, beliefs, perceptions, and values about safety. A culture of safety is essential in high reliability organizations and is a critical mechanism for the delivery of safe and high-quality care. It requires a strong commitment from leadership and staff. In this course, a safe culture is promoted through the use of identifying and reporting patient safety hazards, accountability and transparency, involvement with patients and families, and effective teamwork.
The Influence of Safety Culture on Patient and Provider Outcomes
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En provenance du cours de Johns Hopkins University
Setting the Stage for Success: An Eye on Safety Culture and Teamwork (Patient Safety II)
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Patient Safety Culture and Just Culture
In this module, learners will develop an understanding of what safety culture is and why it matters, how safety culture influences outcomes, how culture is assessed, and how strategies for improvement can be developed. Learners will become familiar with the Just Culture model and how it is used when appropriating blame and accountability for human error, at risk behaviors, and reckless behaviors.
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Eileen Kasda
[MUSIC]
So now that we have defined patient safety culture,
let's talk about a little bit why it matters.
And for some of you that's probably rings through and
you have an inherent understanding of why this matters.
But let's specifically talk a little bit about its impact on patient and
provider outcomes.
So as we know, culture is the way we do things around here.
And of course, that stems from our underlying assumptions and espoused
values of our organization or our units, or maybe even our own personal selves.
And, because that's how we do things around here,
it really influences our job attitudes, our behaviors,
the way we think about our job, the way we approach things when we're working.
And unsurprisingly, and somewhat obviously, those behaviors,
those attitudes and cognitions influence then the patient and
family member safety, as well as our healthcare worker safety.
And not just those folks who have you know close proximity to patients, but
also anyone who works within an healthcare industry.
Whether we clean up the floors quickly
in case of spillage can affect anybody who walks down the hallway.
And so, that's the ultimate reason why it matters.
But what kind of outcomes can we expect?
And what do we know from the literature that that patient safety
culture is tied to?
Well, when it comes to our patients, who for most of us are at the heart of what,
the reason why we do what we do, it really can affect their care experience.
It affects the adverse events that they experience.
Those with stronger safety cultures generally tend to
experience less adverse events.
And if you we're with me, you remember that it's a little bit of a misnomer to
characterize safety culture as strong or
weak when you can look at all these different pieces of the puzzle.
But, for sake of simplicity, we'll talk about it in that way.
And those that have stronger safety cultures generally have fewer treatment
errors and less mortality.
And so, what we find is that when we can improve patient safety culture,
we improve these patient outcomes,
which are really at the heart of what we're trying to do anyway.
However, I find that patient safety culture, when we talk about that and
we talk about the patients and the family members,
everybody is completely on board with that.
Everybody thinks immediately about the patient as we should.
However, I also encourage everybody not to forget about the workers who
also can experience benefits from an improved safety culture.
I think it's important to remember that those of us who work in healthcare
environments also can experience
worsened outcomes in the event of a poorer safety culture.
And so some of those incidents include incident reporting.
And cultures and unit cultures where people are penalized for
errors, incident reporting actually reduces.
And so while for some folks they see that as, that's great,
it means we're having fewer incidents, that's not necessarily the case.
Sometimes that we see in safety cultures and
unit cultures that have a lot more openness to learning from mistakes,
we actually see that incident reporting goes up.
And the reason for that is people are less fearful of inserting reports into
the system and learning from errors and sharing about mistakes that they've made.
And so that could actually be seen as a positive thing.
And so, when we have stronger safety cultures or
at least a culture that's less focused on penalizing folks for
making human mistakes, we actually see that incident reporting can go up.
We see that workplace injury can go down, too, in safety culture.
So obviously, we don't want our patients to experience any adverse events,
but neither do we want our clinicians and our workers to slip in the hallway.
Burnout and turnover and engagement are also really popular outcomes that
are currently under a lot of investigation,
that are getting a lot of buzzword on the street.
And these are also related to a safety culture.
Stronger cultures, make for better places to work.
So engagement in your job improves, turnover reduces, and
we can even see a relationship with burnout.
That those folks who work in places where they feel their safety is being cared for
experience less burnout.
And finally, safety culture influences how other interventions
are received within our organizations and that makes sense, right?
Because it's all about what we do here and how we approach things.
And so, if we have a culture that's very resistant to new ideas or
new practices, that's going to influence whether or
not a new intervention or a new checklist or
a new protocol is accepted in our organizational context, right?
And it makes perfect sense.
So when we're talking about trying to improve other things on the job,
whether they're clinical outcomes or how we interact with each other.
Our culture, our safety culture, those language patterns,
those teamwork behaviors,
our leadership really can influence how well those interventions go too.
The good news about safety culture is that it's co-created on a daily basis.
So what that means is culture can change.
Now, it changes slowly.
It definitely does not change overnight, but
because think back to that lily and think back to the stem and the roots.
Slowly, over time, our attitudes, our behaviors and
our way of thinking can change.
Again, as I said, it doesn't change overnight.
Nobody's won an argument and
had suddenly somebody go, you know, that's absolutely correct.
I'm going to change my entire life philosophy because of your point.
Sometimes it's a little bit harder,
a little bit slower to digest and accept, but it does happen.
And so because of that, because we can change our behaviors,
because we can slowly in time change their way of thinking,
when new folks come in who have different ways of doing things,
sometimes they completely integrate into our culture.
But sometimes, they bring a fresh perspective,
especially if they are in a leadership position that can
actually get us to think differently about how we approach things.
So, while we see that culture can influence our attitude, behavior and
cognitions.
And those of course affect the outcomes that we've discussed.
We also can see it go up the other way.
Sometimes we see that things didn't go the way that we wanted them to in
a particular event.
And so we automatically modify our behavior to learn from that
experience the next time, and we improve solely over time.
And we find we start to hone in on what's working and what isn't.
And so as we change our behavior,and as our attitudes then slowly change, and
our cognitions and our way of approaching our jobs, and our perspective change,
the culture slowly begin to change.
Again, slowly.
[LAUGH] But if you are interested in trying to change your culture,
it can be done through different interventions.
However with a caveat that our best evidence
is first to use multiple components within an intervention.
So think back to that circle with our feedback and
correction policies, our leadership approaches, our teamwork policies.
Trying to target as many pieces of the safety culture puzzle or the safety
culture pie at one time is going to see us greater gains in the long run.
And so that's essentially what our evidence has been showing us.
Now, bad habits develop when our culture is ignored or
when it's not actively managed.
As human, we drift.
And this idea of drift is this idea that slowly, we have the best of intentions.
And one day, we're really motivated to do something by best practice,
even if that best practice is really different from what we're used to.
And so, maybe for a little while,
we really are committed to doing it the right way, the perfect way.
But then slowly, over time, we have a tendency to drift, which means we
slowly start to go back to maybe how we used to do things but it's incremental.
I don't know, maybe many of you are like me and
have tried multiple diets in your life.
Well, if you're also like me, you will sometimes go all in.
And then, you'll realize you're working out five days a week and that's wonderful.
And it's going really well, and then one week you're tired and
your work out four days a week.
And the world didn't end, so the next week, you only work out three days.
And slowly over time, you get back to your couch potato habits.
I get back to my couch potato habits.
And we realize it's time to try to mindfully manage it back to
the best practice where we ultimately want it to be.
So what's interesting about this is is trying to be
mindful of your work area's culture and yet the change paradox.
The change paradox is this idea that we want to do what's easy.
Parsimony is great.
We, the path of least resistance is usually the best path to go down.
Except for when it keeps us from thinking about why we're going that way.
And so when we are trying to establish new practices,
sometimes it's a checklist isn't going to do it.
Sometimes, we have to get into the nitty-gritty adaptive work and
focus on teamwork interactions and how we speak to one another because it
requires us to engage in conscious reflection.
And that conscious reflection is what's needed for us to change our behavior.
So when we're trying to change our safety culture,
it does require a little bit of mindfulness and focus.
It also requires everybody on board, as we're going to talk about in a little bit.
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