1. Fostering a Culture of Safety in a Health Care Environment

2. Presentation Outline ä Culture of Safety for Health Care Workers ä How to Create a Culture of Safety in a Health Care Environment ä Providing and Maintaining Safe Patient Care Environments ä Knowledge Transfer ä Staff Buy-In & Management/Leadership Support

3. What Do Effective Safety Cultures Have in Common? ä Corporate Culture demonstrates a constant commitment to safety as a top-level priority. ä This attitude permeates the entire organization. ä There are common components….

4. What Do Effective Safety Cultures Have in Common? Common Components ä Acknowledgement of the high risk, error-prone nature of the organizations activities ä Blame-free environment – employees can report errors or close calls w/out punishment ä Expectations of collaboration across ranks to seek solutions to vulnerabilities ä Willingness on the part of the organization to direct resources to address safety concerns ä Provision of a Safe Work Environment

5. 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)

6. Language Culture is... ä Learned ä Shared ä Contains multiple facets Artifacts Social Interaction Material Life Knowledge Transfer Mechanisms Values

7. 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 Injury/accident vs Safety and Minimizing Risk Artifacts:Equipment/Technology used Outdated lifting equipment vs state-of-the art equipment

8. The Culture of Safety for Health Care Workers Social interaction: How members interact. Top down approach vs employee empowerment C aring 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

9. 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

10. 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

11. What differences are seen in a Culture of Safety and a Culture of Blame? The Culture of Safety for Health Care Workers

12. Blame and Gain Behaviors* JudgingvsExploring Showing emotion vsRemaining calm Reacting to what vs Finding out exactly you think happenedwhat happened Blaming people forvsFocusing on the process getting it wrongthat allowed mistake to happen *Pearn, Mulrooney & Payne, 1998

13. Blame and Gain Behaviors* Finding faultvsProving support Focusing on effects vsFocusing on causes Assuming the person vs Assuming the person should feel guiltywants to learn Seeing mistakes asvsSeeing mistakes as something that mustpart of a learning be avoided process *Pearn, Mulrooney & Payne, 1998

14. Gain (Safety) Cultures ä People learn from their mistakes ä People avoid making the same kind of mistakes by sharing the lessons learned ä When mistakes occur people take responsibility for them Sitkin, 1992

16. How to Create a Culture of Safety in a Health Care Environment Management/Leadership Support Knowledge Transfer Mechanisms Safe Patient Care Environment Staff Buy-In/Support

17. 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

18. Unsuccessful Solutions ä Over the past 30 years, efforts to reduce injuries have been largely unsuccessful ä Interventions have focused on ä body mechanics education ä ä training in lifting techniques ä ä Culture of Safety concept was unknown/ignored

19. Successful Solutions VISN-Wide Deployment of a Back Injury Prevention Program for Nurses: Safe Patient Handling and Movement

20. Safe Patient Handling & Movement Program ä Uses Patient Care Ergonomics to select appropriate Patient Handling Equipment ä Includes continual Environmental Hazard Evaluation ä Includes Program & Equipment Support Structures ä SPHM Team ä Peer Leaders ä SPHM Policy ä Knowledge Transfer Mechanisms

21. Safe Patient Handling & Movement Program ä Knowledge Transfer Mechanisms ä Mechanisms to obtain AND supply information ä After Action Review ä Unit Peer Leaders (Back Injury Resource Nurses) ä Assessment, Algorithms, & Care Plan for Safe Patient Handling & Movement

22. How to Create a Culture of Safety in a Health Care Environment Management/Leadership Support Knowledge Transfer Mechanisms Safe Patient Care Environment Staff Buy-In/Support

23. Culture of Safety Knowledge Transfer… fosters a Culture of Safety

24. Knowledge Transfer ä Knowledge transfer is the sharing of common knowledge. ä Common knowledge is what we learn in doing our work (Dixon 2000). ä Common knowledge can be either tacit (i.e. residing in peoples heads) or explicit (i.e. can be written down into a series of steps or guidelines).

25. Mechanisms of Knowledge Transfer Learning Before Peer Leaders (BIRNS)Peer Leaders (BIRNS) Failure Mode & Effect Analysis (FMEA)Failure Mode & Effect Analysis (FMEA) Best PracticesBest Practices AARAAR Learning After Accident Review Boards (ARB)Accident Review Boards (ARB) Root Cause Analysis (RCA)Root Cause Analysis (RCA) Safety Investigations (OSHA)Safety Investigations (OSHA) Educational OutreachEducational Outreach Best Practices SystemsBest Practices Systems EpidemiologyEpidemiology After Action Review (AAR)After Action Review (AAR) Learning During Individual ImprintingIndividual Imprinting Personal ExperiencePersonal Experience Human Action

26. Knowledge Transfer… ä ä Fosters a Culture of Safety ä ä Solves problems quickly ä ä Facilitates implementation of best practices effectively and efficiently ä ä Empowers staff by using the knowledge they possess

27. How to Create a Culture of Safety in a Health Care Environment Management/Leadership Support Knowledge Transfer Mechanisms Safe Patient Care Environment Staff Buy-In/Support

28. How to Create a Culture of Safety in a Health Care Environment How can your organization achieve... Staff Buy-In/Support? Management/Leadership Support?

29. How to Create a Culture of Safety in a Health Care Environment Utilize Change Strategies ä Use Social Marketing ä Involve Front-line Workers ä Ensure Staff are Competent in Use of Program Elements & Equipment ä Use Unit Peer Leaders ä Develop Action Plans

30. 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!!

31. Social Marketing in Health Care Distressed, yes, but remember… There is no such thing as RESISTANCE – only REACTIONS to change!

32. Social Marketing in Health Care ä What is the response when a behavior is viewed as being resistant to change? ä Listen less ä Emotions escalate ä Blame the person

33. Social Marketing in Health Care ä What is the response when the behavior is viewed as reactions to change? ä Listen more ä Emotions diminish ä Problem solve

34. 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?

35. Responsibilities of Front Line Staff ä Accept leaders invitations to play ä Learn about and practice systems thinking ä Team with management ä Team with co-workers ä Commit to improving communication across organizational levels, units, and among peer group

36. Role of Leaders & Managers ä Demonstration of a constant commitment to safety as a top-level priority. ä Facilitating the permeation of this attitude through the entire organization.

37. Know….. A Culture of Safety is Attainable…