Safety culture has been described as the common values, beliefs, and behavioral practices associated with patient safety. It’s a shared mindset among a team, unit, or organization regarding what is considered important, how things operate, and the way things are done (Fondahn et.al., 2016). The concept of safety culture was derived outside of healthcare, from high-reliability organizations such as aviation and nuclear power industries.
These organizations are characterized by complex systems, with a high risk for harm, that are able to minimize adverse events by prioritizing safety. This commitment to safety occurs at all levels, from frontline staff to management and executive levels. A culture of safety is described as having the following qualities:
- Recognition of an organization’s operations as high risk, and prioritization to develop and maintain safe processes
- An environment that supports reporting of errors and near misses without fear of punishment
- An environment that supports collaboration across all levels to better understand problems and develop solutions to safety issues
- Organizational commitment to supporting the resources necessary to develop and maintain a culture of safety such as equipment, staffing, leadership positions focused on quality and safety, etc. (Agency for Healthcare Research and Quality, 2019)
As the patient safety movement evolved, this concept of safety culture and the lessons learned from high-reliability organizations were applied and integrated into healthcare. Establishing a culture of safety is a key component of preventing patient harm and improving patient outcomes. Consider this example that reflects developing and maintaining safe processes, collaboration, and an environment that supports speaking up with safety concerns.
An evidence-based process is put in place to eliminate elective delivery under 39 weeks (early-term delivery that is not medically indicated). A formal scheduling and screening process is developed to ensure that patients under 39 weeks gestation do not arrive to labor and delivery for induction or scheduled cesarean section that is not medically indicated. All staff is educated on these guidelines and regular discussions help to create heightened awareness on the topic as another layer of defense.
A patient arrives for a scheduled repeat cesarean delivery at 38 weeks 6 days due to a scheduling error that is immediately recognized by the primary nurse and reported to the charge nurse and resident. The issue is arced up the chain of command and the patient is ultimately sent home. Potential harm in the form of newborn complications is mitigated because the culture empowers frontline staff to question the situation, advance up the chain as needed for clarification, and report this error in real-time. To prevent this from happening again, the event is investigated to determine how the scheduling error occurred and system changes are put into place. In addition, this information is shared with staff as a good catch.
The team recognized the event as high risk, reported the error in real time, collaborated to determine the next steps, and further work was done to create a stronger system to prevent future events from occurring. These all exemplify characteristics of a strong culture of safety.
References
Agency for Healthcare Research and Quality.(2019, September). Culture of Safety. Retrieved from https://psnet.ahrq.gov/primer/culture-safety
Agency for Healthcare Research and Quality.(2019, September). High Reliability. Retrieved from https://psnet.ahrq.gov/primer/high-reliability
Fondahn, E., Lane, M., & Vannucci, A. (2016). The Washington manual of patient safety and quality improvement. Wolters Kluwer.
Great article.
Thank you Bronda!