Transcript Qualitative Research: Fact not Fiction

Fostering a Culture of Safety in a
Health Care Environment
Presentation Outline
Culture of Safety for Health Care Workers
 How to Create a Culture of Safety in a
Health Care Environment
 Providing and Maintaining Safe Patient
Care Environments
 Knowledge Transfer
 Staff Buy-In & Management/Leadership
Support

What Do Effective Safety Cultures
Have in Common?
Corporate Culture demonstrates a
constant commitment to safety as a
top-level priority.
 This attitude permeates the entire
organization.
 There are common components….

What Do Effective Safety Cultures
Have in Common?
Common Components


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Acknowledgement of the high risk, error-prone
nature of the organization’s activities
Blame-free environment – employees can report
errors or close calls w/out punishment
Expectations of collaboration across ranks to
seek solutions to vulnerabilities
Willingness on the part of the organization to
direct resources to address safety concerns
Provision of a Safe Work Environment
What is ‘Culture’?
“Culture is patterns of behavior that are
acquired and transmitted by symbols
created by humans, including their
embodiments in artifacts.
The essential core of culture consists of
traditional ideas and their attached values.
(Kroeber & Kluckhorn, 1952)
Culture is...



Learned
Shared
Contains multiple facets
Language
Artifacts
Material Life
Social
Interaction
Values
Knowledge Transfer
Mechanisms
The Culture of Safety
for Health Care Workers
Language: The way our culture is described.
Injury/accident vs Safety and
Minimizing Risk
Artifacts: Equipment/Technology used
Outdated lifting equipment vs
state-of-the art equipment
The Culture of Safety
for Health Care Workers
Social interaction: How members interact.
Top down approach vs employee
empowerment
Caring for patients according to safety
guidelines vs co-workers guided by a collective
and joint belief in the importance of safety,
with the shared understanding that every
member upholds the group's safety norms
The Culture of Safety
for Health Care Workers
Values:
Productivity vs maintaining a
safe environment of care
Material Life: Procurement of equipment by
purchasing department vs active
involvement of front line
workers in choice of equipment
The Culture of Safety
for Health Care Workers
Knowledge Transfer:
The sharing of common knowledge - what
we learn in doing our work (Dixon 2000).
Following procedures and policies vs
utilizing employees’ knowledge of their jobs
The Culture of Safety
for Health Care Workers
What differences are
seen in a Culture of
Safety and a Culture
of Blame?
Blame and Gain Behaviors*
Judging
vs
Exploring
Showing emotion
vs
Remaining calm
Reacting to what
you think happened
vs
Finding out exactly
what happened
Blaming people for
getting it wrong
vs
Focusing on the process
that allowed mistake to
happen
*Pearn, Mulrooney & Payne, 1998
Blame and Gain Behaviors*
Finding fault
vs
Proving support
Focusing on effects
vs
Focusing on causes
Assuming the person
should feel guilty
vs
Assuming the person
wants to learn
Seeing mistakes as
something that must
be avoided
vs
Seeing mistakes as
part of a learning
process
*Pearn, Mulrooney & Payne, 1998
“Gain (Safety) Cultures”
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People learn from their mistakes
People avoid making the same kind of
mistakes by sharing the lessons learned
When mistakes occur people take
responsibility for them
Sitkin, 1992
If th e last w ord s of you r em p loyee, b efore rep ortin g to E m p loye e
H ealth w ere, “H ey gu ys, w atch th is!”, you p rob ab ly d o n ot h ave
th e safety cu ltu re you w an t.
How to Create a Culture of Safety
in a Health Care Environment
Staff Buy-In/Support
Knowledge
Transfer
Mechanisms
Management/Leadership
Support
Safe Patient Care
Environment
Provide/Maintain a Safe
Patient Care Environment
Nursing is a High Risk
Occupation…
You CANNOT have a Culture of
Safety without Control
Measures in place to reduce
risk for Nursing Staff
Unsuccessful Solutions

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Over the past 30 years,
efforts to reduce injuries
have been largely
unsuccessful
Interventions have
focused on
 body mechanics education
 training in lifting
techniques
Culture of Safety concept
was unknown/ignored
Successful Solutions
VISN-Wide Deployment of a
Back Injury Prevention
Program for Nurses: Safe
Patient Handling and
Movement
Safe Patient Handling &
Movement Program

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Uses Patient Care Ergonomics to select
appropriate Patient Handling Equipment
Includes continual Environmental Hazard
Evaluation
Includes Program & Equipment Support
Structures
 SPHM Team
 Peer Leaders
 SPHM Policy
 Knowledge Transfer Mechanisms
Safe Patient Handling &
Movement Program

Knowledge Transfer Mechanisms
 Mechanisms
information
 After
to obtain AND supply
Action Review
 Unit Peer Leaders (Back Injury
Resource Nurses)
 Assessment, Algorithms, & Care Plan
for Safe Patient Handling &
Movement
How to Create a Culture of Safety
in a Health Care Environment
Staff Buy-In/Support
Knowledge
Transfer
Mechanisms
Management/Leadership
Support
Safe Patient Care
Environment
Culture of Safety
Knowledge Transfer…
fosters a Culture of Safety
Knowledge Transfer
Knowledge transfer is the sharing of
common knowledge.
 Common knowledge is what we learn in
doing our work (Dixon 2000).
 Common knowledge can be either tacit
(i.e. residing in people’s heads) or explicit
(i.e. can be written down into a series of
steps or guidelines).

Mechanisms of
Knowledge Transfer
Human Action
Learning Before
• Peer Leaders
(BIRNS)
• Failure Mode &
Effect Analysis
(FMEA)
• Best Practices
• AAR
Learning During
• Individual
Imprinting
• Personal
Experience
Learning After
• Accident
Review Boards
(ARB)
• Root Cause
Analysis (RCA)
• Safety
Investigations
(OSHA)
• Educational
Outreach
• Best Practices
Systems
• Epidemiology
• After Action
Review (AAR)
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 Environment
Staff Buy-In/Support
Knowledge
Transfer
Mechanisms
Management/Leadership
Support
Safe Patient Care
Environment
How 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 Environment
Utilize Change Strategies
Use Social Marketing
 Involve Front-line Workers
 Ensure Staff are Competent in Use of
Program Elements & Equipment
 Use Unit Peer Leaders
 Develop Action Plans

How 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 Care
Distressed, yes, but remember…
There is no such thing as
RESISTANCE –
only REACTIONS to change!
Social Marketing in Health Care

What is the response when a behavior is
viewed as being ‘resistant’ to change?
 Listen less
 Emotions escalate
 Blame the person
Social Marketing in Health Care

What is the response when the behavior is
viewed as ‘reactions’ to change?
 Listen more
 Emotions diminish
 Problem solve
How 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 Staff
Accept leaders’ invitations “to play”
 Learn about and practice ‘systems
thinking’
 Team with management
 Team with co-workers
 Commit to improving communication
across organizational levels, units, and
among peer group

Role of Leaders & Managers
Demonstration of a constant
commitment to safety as a top-level
priority.
 Facilitating the permeation of this
attitude through the entire
organization.

Know…..
A “Culture of Safety”
is Attainable…