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CULTURE

“A resilient organization treats safety as a core value, not a commodity that can be counted. Indeed, safety shows itself only by events that do not happen!”

- Erik Hollnagel, PhD, in Resilience Engineering

Foster a collaborative culture

Everyone in the organization plays an important role in protecting patients and it takes work to ensure that all members of the team feel they can report mistakes or voice safety concerns knowing they will be heard, responded to, and not punished (barring negligence or misconduct). This is the cornerstone of an environment — or culture — that prioritizes patient safety. It can take time to build a strong patient safety culture; it requires conscious effort and steady leadership.

Know these six principles of a robust patient safety culture
  • The organization considers safety a necessity.
  • Clear and open communication among staff is fostered.
  • A constructive learning system develops; information and data is used for learning not for judgment.
  • Teamwork is valued.
  • The organization elicits and is responsive to input from patients and families.
  • Staff members feel comfortable raising concerns with anyone at the organization, including with a supervisor or other role with greater experience or responsibility.
Lay the groundwork
  • Include patient safety as an agenda item for every staff meeting. Offer praise for recent successes and discuss concerns or suggestions to improve.
  • Hold small group conversations about teamwork and communication at your organization. Do staff members believe they work well together as a team? Are there ways to improve interactions or the flow of key information.
  • Take time with staff across all areas to discuss any proposed changes to office or unit processes, their purpose, and their impact.
  • Assess your organization’s current culture and performance. Use a tool such as:
    • These Culture Check-in Questions for Management and Leadership or
    • The Safety Attitudes and Safe Climates Questionnaire (SAQ):
      • Complete the first 13 questions of the short form to measure teamwork and safety at your organization and evaluate using the scoring key.
      • For more about the SAQ, including a selected bibliography with examples of questions adapted for different healthcare settings, see the Center for Healthcare Quality and Safety.
Build for sustainable collaboration
  • Hold open, ongoing conversations about patient safety. Talk about:
    • Concerns from staff in any area or function.
    • “Close calls:” events that could have caused harm, but were stopped before they reached the patient.
    • Adverse events: events that caused harm to patients (see Preparation for tools for preparing to respond to adverse events).
  • Provide avenues for patients and families to speak up about safety concerns and actively solicit their input.
  • When you recruit new staff members, look for individuals suited to a collaborative culture. Finding individuals who are a good fit will also help with retention.
Focus on finding safety issues in processes or the environment
  • Remember that the goal of patient safety efforts is to improve systems in your organization in order to protect patients, not to find an individual to punish when something’s gone wrong.
  • Encourage staff to speak up about concerns and to be receptive to feedback in return. Always thank staff for raising concerns to reinforce the important of bringing attention to potential issues.
  • Develop plans for how your organization will handle instances where individuals engage in criminal, negligent, or intentionally unsafe behavior.
Work together as a team across your organization
  • Involve groups of staff from multiple areas that may not always work together in developing new patient safety initiatives or care delivery improvements.
  • Create ways for staff across all areas to talk about preventing harm (see Communication for tips).

Plan

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