Creating a Culture of Safety
To create substantial changes in an organization's culture, senior leaders and frontline staff alike must be involved. The following tools can help establish the culture necessary to make patient safety a top priority.
Resources
Strategies for Leadership: Hospital Executives and Their Role in Patient Safety
Developed by the Dana-Farber Cancer Institute, this 46-element checklist assesses leaders' readiness to assume important roles in patient safety. Although developed in 2002, this tool is still relevant to the core competencies necessary for leaders as they help their organizations create and sustain a fair and just culture.
Creating a Culture of Safety by Focusing on Attitudes
Presenters: Bette Barlond, RN, BSN and Christopher Johnston, PharmD
United General Hospital, Sedro Woolley, WA
Session recorded 2/24/09 Help with WebEx files
Handout United General Hospital’s key staff describe their experience over the past several years with administering the AHRQ Patient Safety Survey three times, assessing the results, and using those results to implement highly successful change programs.
Success Story: Focused attention fuels quality improvement efforts at home health agency
“I feel pretty proud of what we’ve accomplished,” Joan Warren, RN, Performance Improvement Coordinator at Olympic Medical Home Health, said about her agency’s quality measures. She and the rest of the staff of the Port Angeles, WA-based agency have ample reason to be proud—they are above national benchmarks on nearly every measure reported at the Center for Medicare & Medicaid Services’ Home Health Compare website, and are continuing to make steady improvements beyond those levels.
Read the full article, excerpted from the Summer 2006 Home Health Advance.
Patient Safety and the Just Culture: A Primer for Health Care Executives
Author David Marx, JD, provides suggestions for re-evaluating the processes used to hold practitioners accountable for their behaviors, and explores how to foster an open culture where it is possible to learn from mistakes in healthcare. This 28-page primer describes a Medical Event Reporting System (MERS) based on transfusion medicine.
Safety Briefings
Developed by the Institute for Healthcare Improvement (IHI), "Safety Briefings" are a simple tool that frontline staff can use on a daily basis to share information about potential safety problems and concerns. This 10-page instructional booklet provides detailed instructions for implementing Safety Briefings in healthcare organizations.
Leadership WalkRounds
Developed by Institute for Healthcare Improvement (IHI), this process for implementing weekly, patient-safety focused rounds helps demonstrate an organization's commitment to building a culture of safety.
Sensemaking Guidelines
Nancy Dixon, of Common Knowledge Associates, developed the Sensemaking Guidelines as part of a CMS Patient Safety Learning Pilot. "Sensemaking" conversations can provide an opportunity for hospital leadership and staff to explore and understand unexpected, ambiguous, or novel events within an organization. The guidelines explain the concept of sensemaking, outline clear steps to creating sensemaking conversations, and provide practical examples of how this powerful tool can be used as part of creating a culture of safety.
