Keeping Patients Safe Transforming the Work Environment of Nurses (2004) / Chapter Skim
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7 Creating and Sustaining a Culture of Safety
7 Creating and Sustaining a Culture of Safety
Pages 286-311
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From page 286... ...
Employees also are empowered to act in dangerous situations to reduce the likelihood of adverse events. The environment is fair and just appropriately recognizing the relative contributions of individuals and systemic organizational features to errors, supportive of staff, and fosters continuous learning by the organization as a whole and its employees.
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From page 287... ...
This chapter begins by reviewing the essential elements of an effective safety culture, and then addresses the need for a long-term commitment to create such a culture. Barriers to safety cultures found in nursing and external sources are examined next.
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From page 288... ...
Leadership actions that management can take include the following: · Undergoing formal training to gain an understanding of safety culture concepts and practices (Carnino, undated)
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From page 289... ...
In a safety culture, all who work within the organization are actively involved in identifying and resolving safety concerns and are empowered to take appropriate action to prevent an adverse event (Spath, 20001. Creating such attitudes and behaviors in workers requires many of the same practices recommended in the preceding chapters ongoing, effective, multidirectional communication; the adoption of nonhierarchical decisionmaking practices; empowering of employees to adopt innovate practices to enhance patient safety; and a substantial commitment to employee training)
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From page 290... ...
Constrained Improvisation In organizations with strong safety cultures, employees have permission and indeed are encouraged to engage in "constrained improvisation" (Moorman and Miner, 1998; Weick, 1993) when doing so furthers the goals of the organization.
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From page 291... ...
. Rewards and Incentives In a culture of safety, people are rewarded for their involvement in safety improvements, whether as individuals or as members of safety improvement teams, safety committees, or participants in safety meetings (Carnino, undated; Spath, 20001.
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From page 292... ...
lust 16 months after the piloting of the Veterans Administration's (VA) Patient Safety Improvement Initiative, the VA observed a 30-fold increase in reported events and a 900-fold increase in reported near misses for events designated as "high priority." This increase was attributed, in part, to the VA's emphasis on a nonpunitive approach to error reporting (Bagian et al., 20011.
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From page 293... ...
A near miss is an event that could have had adverse consequences but did not; it is indistinguishable from a full-fledged adverse event in all but outcome. Examples of near misses are a nurse giving a patient an incorrect medication from which the patient suffered no adverse consequences, and a nurse programming the wrong rate of flow for an intravenous infu
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From page 294... ...
and the existence of a corrective action program are positive indications of a good safety culture (Carnino, undated; Spath, 20001. Injury-producingincidents and significant near misses are investigated for their root causes, and effective preventive actions are taken (Pizzi et al., 2001)
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From page 295... ...
Some have estimated that it can take 5 years to develop a culture of safety that permeates the entire organization (Manasse et al., 20021. The International Atomic Energy Agency, which has monitored and
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From page 296... ...
: · Stage 1 Safety management is based on rules and regulations. · Stage 2 Good safety performance becomes an organizational goal.
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From page 297... ...
People clo not unclerstanci why acicleci controls fail to yield the expected results in safety performance. In this stage, the organization establishes a vision of the clesireci safety culture and communicates it throughout the organization.
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From page 298... ...
In Stage 3, safety performance is viewed as dynamic and always amenable to improvement. The organization has adopted the idea of continuous improvement and has applied the concept to safety.
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From page 299... ...
BARRIERS TO EFFECTIVE SAFETY CULTURES FROM NURSING AND EXTERNAL SOURCES As HCOs undertake the creation of a culture of safety, they must dedicate the internal personnel and other resources required to effect the needed changes. They must also deal with two barriers that must be overcome if they are to achieve the maximum benefit from their efforts one that originates in the nursing profession (and also is found among other health professionals)
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From page 300... ...
One result of this situation is that the consequences of litigation for the nurses involved in these and similar adverse events, in which nurses were fined, fired, sued, or otherwise punished (Serembus et al., 2001; Sexton, 1995) , create serious disincentives to disclosure of errors or near misses on the part of nurses and other health professionals.
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From page 301... ...
Federal legislation could remedy this situation, providing uniform national protection for the creation of cultures of safety in HCOs (IOM, 20001. This concept also has been endorsed by the Medicare Payment Advisory Commission, which has recommended that Congress enact legislation to protect the confidentiality of individually identifiable information relating to errors in health care delivery when that information is reported for quality improvement purposes (Medicare Payment Advisory Commission, 19991.
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From page 302... ...
Ensuring confidential reporting of errors, using fair and just procedures for assessing causation, and extending peer review protections to data collected by HCOs together can reduce the disincentives to error reporting that thwart the detection and prevention of error-producing situations.
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From page 303... ...
. In 2003, NAVAHO also began requiring accredited organizations to meet annually specified patient safety goals.
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It serves as an oversight body to ensure the advancement of the safety program and to create the policies and procedures needed to implement the program. The Safety Board is also responsible for medical management, risk management, and quality management.
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From page 306... ...
in the United States, undertook the creation of a culture of safety throughout the organization as part of a Patient Safety Plan initiated in 2001. This initiative is aimed at: · Creating a strong patient safety culture, with patient safety embraced as a shared value.
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From page 307... ...
· Safe patients Engaging patients and their families, as appropriate, in reducing medical errors, improving overall system safety performance, and maintaining trust and respect. Kaiser Permanente formed an internal National Patient Safety Advisory Board to guide this initiative, provide a forum for information sharing, and help integrate safety into the fabric of the organization.
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From page 308... ...
This instrument the Hospital Survey on Patient Safety is in the final stages of testing and validation and is scheduled to be available in the public domain in early in 2004. It will allow health care institutions to understand the varying safety cultures within their own institutions, how staff view the commission of errors and error reporting, and the extent to which staff perceives the institution to be a safe place for patients.2 By themselves, however, surveys of the safety climate (i.e., the aggregation of individuals' attitudes and perceptions about safety)
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From page 309... ...
· Conducting an annual, confidential survey of nursing and other health care workers to assess the extent to which a culture of safety exists. · Instituting a deidentified, fair, and just reporting system for errors and near misses.
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From page 310... ...
The National Council of State Boards of Nursing, in consultation with patient safety experts and health care leaders, should undertake an initiative to design uniform processes across states for better distinguishing human errors from willful negligence and intentional misconduct, along with guidelines for their application by state boards of nursing and other state regulatory bodies having authority over nursing. Recommendation 7-3.
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From page 311... ...
Washington, DC: National Academy Press. JCAHO (Joint Commission on Accreditation of Healthcare Organizations)
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