Current strides in improving patient safety in hospitals and medical facilities provide clear evidence that the healthcare industry has the capacity for meaningful change. However, providers continue to face significant obstacles; perhaps the biggest obstacle of all revolves around developing and expanding a vigorous “safety culture.” Indeed, much of the focus has been on technology and incremental process improvement, but building a “culture” is the foundational contributor to ensuring patient safety.

A recent report by the National Patient Safety Foundation (NPSF), Free From Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err is Human, acknowledged that “patient safety concerns remain a serious public health issue.” Their expert panel provided recommendations that will, no doubt, have a positive effect on the future of healthcare practice, the most important of which is building a patient safety culture.

The first and most straightforward recommendation of the NSPF expert panel was: “Ensure that leaders establish and sustain a safety culture.” Creating an organization-wide culture of safety from the top down in healthcare organizations is paramount for the future establishment of safety initiatives.

Other industries are far ahead of healthcare in the establishment of cultures that encourage and enforce safety policies and protocols. The aviation industry, for example, realized decades ago that the transformation to a culture of safety would dramatically reduce airline accidents and save lives.

According to the Agency for Healthcare Research and Quality (AHRQ), the safety culture of an organization should exhibit the following characteristics:

• Understanding of the organization’s “high-risk” activities
• Constant striving for safe operations
• Blame-free environment; transparent reporting of mistakes without fear of punishment and reprisal
• Collaboration across all hierarchies and specialties to create patient safety safeguards and to resolve safety issues
• Commitment of the organization to provide resources to address safety issues

The initial model for creating a culture of safety was borrowed from the AHRQ’s high reliability organizations (HROs). These are organizations that carry out tasks that are complicated and dangerous, yet the overriding emphasis is on safety: minimizing errors, adverse events and catastrophic situations. High reliability is reflected in a safety commitment throughout the organization. The AHRQ explains that HROs display the following:

• Preoccupation with failure. Personnel are always thinking about threats and what could go    wrong. Near misses are seen as learning opportunities.
• Reluctance to simplify. Workers understand that their jobs are complex. Team members seek detailed rationales rather than quick, simple answers.
• Sensitivity to operations. Staff members are sensitive to the situation around them and how it could create an unsafe or threatening situation. This is often referred to as “situation awareness” or “big-picture understanding.”
• Deference to expertise. Leadership will allow the most experienced and knowledgeable individual to handle a crisis situation rather than simply the highest ranking individual present.
• Commitment to resilience. “People in HROs assume the system is at risk for failure.” Therefore, practicing “rapid assessments” and appropriate responses to dangerous situations is required.

The challenge remains that there is controversy over the concept of a totally “blame-free” environment. Many leading patient safety advocates believe that accountability must be included as a component of any safety culture. The model of a just culture, on the other hand, incorporates accountability into the classic safety culture. In a just culture, individuals are held accountable for errors that are caused by risky or reckless behavior. For example, in the case of an adverse event caused by a human error or a slip-up, no punitive action would be taken. Conversely, if an individual refused to follow standard safety procedures and policies, punitive action would follow.

The IOM’s landmark report To Err is Human, published over fifteen years ago, served as a wake-up call to the healthcare community. Since that time, efforts have been under way to reduce medical errors and improve patient safety. The creation of a safety culture within individual healthcare organizations will undoubtedly be a significant factor leading to a safer, healthier future.

References:

1. Agency for Healthcare Research and Quality (AHRQ). ”High Reliability.” Patient Safety Primers. http://psnet.ahrq.gov/primer.aspx?primerID=31, Accessed February 16, 2016
2. Agency for Healthcare Research and Quality (AHRQ). “Safety Culture.” Patient Safety Primers http://psnet.ahrq.gov/primer.aspx?primerID=5,Accessed February 16, 2016
3. Moriates, C., Wachter, R. “Accountability in Patient Safety” Agency for Healthcare Research and Quality. PSNet https://psnet.ahrq.gov/perspectives/perspective/189, Accessed February 29, 2016
4. National Patient Safety Foundation “Free From Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err is Human” National Patient Safety Foundation. 2016 http://www.npsf.org/?page=freefromharm Accessed February 29, 2016