culture_of_safety by GXU0j0

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									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
   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                          Social
                                         Interaction
                        Artifacts

    Material Life                            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           Outdated lifting equipment vs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          vs    Finding out exactly
you think happened              what happened
Blaming people for        vs    Focusing on the process
getting it wrong                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       vs      Assuming the person
should feel guilty                wants to learn
Seeing mistakes as        vs      Seeing mistakes as
something that must               part of a learning
be avoided                        process

*Pearn, Mulrooney & Payne, 1998
 “Gain (Safety) Cultures”

   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 the last words of your employee, before reporting to Employee
Health were, “Hey guys, watch this!”, you probably do not have
the safety culture you want.
      How to Create a Culture of Safety
      in a Health Care Environment

Staff Buy-In/Support   Management/Leadership
                              Support




Knowledge
Transfer                 Safe Patient Care
Mechanisms               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
   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
   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   to obtain AND supply
       information

       After 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   Management/Leadership
                              Support




Knowledge
Transfer                 Safe Patient Care
Mechanisms               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
                                      Learning After
    Knowledge Transfer                • Accident
                                        Review Boards
                                        (ARB)
                    Human Action      • Root Cause
                                        Analysis (RCA)
                                      • Safety
Learning Before                         Investigations
• Peer Leaders                          (OSHA)
  (BIRNS)                             • Educational
• Failure Mode &                        Outreach
  Effect Analysis   Learning During   • Best Practices
  (FMEA)            • Individual        Systems
• Best Practices      Imprinting      • Epidemiology
• AAR               • Personal        • After Action
                      Experience        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   Management/Leadership
                              Support




Knowledge
Transfer                  Safe Patient Care
Mechanisms                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…

								
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