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Safety Culture:What, why and how?Michael-Alice Moga, MD MScDepartment of Critical Care MedicineThe Hospital for Sick ChildrenThe University of TorontoCritical Care Canada ForumInterdisciplinary Quality CareOctober 2017
Why shouldI care?What issafetyculture?How do Iassess it?How do Iimprove it?
What is Safety Culture? A textbook definition“The safety culture of an organization is the product ofindividual and group values, attitudes, perceptions,competencies, and patterns of behavior that determine thecommitment to, and the style and proficiency of, anorganization’s health and safety management. Organizationswith a positive safety culture are characterized bycommunications founded on mutual trust, by sharedperceptions of the importance of safety, and by confidence inthe efficacy of preventive measures.”-Committee on the Safety of Nuclear InstallationsOrganizing for Safety: Third Report of the ACSNI (Advisory Committee on the Safetyof Nuclear Installations) Study Group on Human Factors. Health and SafetyCommission (of Great Britain). Sudbury, England: HSE Books, 1993.
What safety culture really isTrustResponsibilityHowSafetywe doCulturesafetySharedPerceptionConfidence
How do I assess safety culture? Surveys AHRQ HSOPSC UT Houston’s SAQ HRO audits PSCHO Relics Safety event reporting Meeting minutes M&M records Dedicated time/people Experience it
your CLABSI rate tripled? a patient got a 100 xoverdose of a narcotic? your department chiefentered an isolation roomwithout PPE? your CEO told you to cutthe unit budget by 25%?
Why should I care?HACMederrorSafetySSEFrontline staff’s assessment morepredictive than that of leadership.CulturePatientoutcomes
Some data .DiCuccio. J Patient Safety. Sept 2015; 11(3): 135-142
Putting it togetherDiCuccio. J Patient Safety. Sept 2015; 11(3): 135-142
How do I change culture if .
The Journey: The DuPont Bradley CurveExternal MotivationCOMPLIANCEInternal MotivationCOMMITMENTRules, procedures, protocolsFelt leadership, role modelling,engagement, influencing“I follow the rules because I have to.”No harm is.Heresy“I follow the rules because I want to.”A dreamReactiveAuthoritarianSource: E. I. du Pont de Nemours and CompanyA goalWORKING STYLELEADERSHIPA choiceProactiveCoaching
How do we get there? Basic principles
How do I get there?The P-D-S-A of Safety Culture InterventionSinger & Vogus. Annu Rev Public Health 2013. 34:373-96
How do I get there?Concrete strategies to improve safety sTeamTrainingWeaver et al. Ann Intern Med. 2013;158(502):369-374CommunicationTools
Strategies to improve safety culture:Executive walk roundsStructure 8/8Process 3/8CulturePerception ofprocessesDays betweenOutcome2/8Cost/LOSWeaver SJ. Ann Intern Med. 2013; 158(502):369-374Frankel A. Health Serv Res. 2008; 43:2050-66O’Leary KJ. J Hosp Med. 2011; 6:88-93
Strategies to improve safety culture:Team training & communication toolsStructure 16/20Process 5/20CultureDelaysUse of toolHarmful errorsOutcome 7/20AO IndexWeaver SJ. Ann Intern Med. 2013; 158(502):369-374
Strategies to improve safety culture:CUSPStructure 6/8Process 2/8Safety cultureTeamworkResolution ofconcernRN turnoverOutcome 4/8HAILOSWeaver et al. Ann Intern Med. 2013; 158(502):369-374
In Summary Safety culture, “how we dosafety,” is a integral part ofexcellent patient care. Set of learned behaviorsrefined by practice of the dailyactivities of a critical care unit. Make safety a core value, nota priority (priorities change). A good safety culture cannotbe assumed, it must beproven, monitored andfostered v
Critical Care Canada Forum Interdisciplinary Quality Care October 2017. What is safety culture? How do I assess it? How do I improve it? Why should I care? What is Safety Culture? A textbook definition “The safety culture of an organization is the product of
