Key to safety: Creating a culture of safety
Key to safety: Creating a culture of safety
Hospital works to change behavior
Are your employees too busy to be safe? Too stuck in their old way of doing things to use new safety equipment?
There's much more to implementing a new safety program, such as safe patient handling, than buying equipment. That's why some hospitals have focused on behavioral management and building a "culture of safety" as the key to improving overall safety.
At Memorial Hospital and Health System of South Bend, IN, CEO Phil Newbold, FACHE, has put safety "at the top of the agenda" at meetings of the hospital's board and senior management and hired Behavioral Science Technology (BST) of Ojai, CA, to help the staff build behaviors that are important to safety.
"If our employees don't feel the management supports the culture of safety for them, then that's a signal that we want it for patients but we don't want the same level of safety for our staff members," Newbold says. "It's pretty hard to separate those two. If they see how interested leadership is in their personal well-being, that will carry over to everything they do for patients and families and visitors."
It takes about five to seven years to change the culture of an institution, says Newbold. But it's the ongoing commitment that will convince employees, he says. "You do it one person at a time by building trust ... by doing what you say you're going to do," he says.
That may mean including safety practices and principles in employee competencies and new employee orientation, as well as demonstration from leadership that safety is important, he says.
Taking a broader look at safety led Memorial to its Safe Moves Initiative, which integrates patient fall prevention and safe patient handling. In the first year of the program, musculoskeletal injuries declined by 37%. Patient falls also have fallen below the benchmark of four per 1,000 patient days.
Separating patient safety and employee safety, as many hospitals do, simply doesn't make any sense, says John Hidley, MD, a psychiatrist who co-founded Behavioral Science Technology. "We find it curious that the health care industry makes a distinction between employee safety and patient safety," he says. "The interventions that work for one work for another."
To build a "culture of safety," Memorial began by defining a safe hospital environment. "We've worked with senior leadership to help them define what they envision that safety ought to be including employee safety and patient safety," says Sharon Dunn, RN, BSN, MAS, practice leader for health care at BST.
BST surveyed employees, including physicians, and began identifying gaps between the safety goals and the realities. For example, BST wants to know how employees perceive leadership's credibility.
"You're trying to create an environment in which the employee feels the leader has his interests at heart and therefore the employee is willing to have the interests of the facility at heart," says Hidley.
Newbold set his goal high. "We hope to be the safest hospital in the United States," he says.
Here are some other important elements of creating a "culture of safety":
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Create a 'culture of justice.'
Memorial conducts a "root-cause analysis" after incidents to determine what went wrong and how similar events could be prevented. The blame-free tone of that accident investigation is crucial, says Newbold.
"We're not blaming people. We're trying to fix systems," he says. "We're more concerned with heading off a problem than spending a lot of time blaming someone."
BST encourages employers also to look at near-misses and to dig deeper to determine why employees may not be complying with safety measures. For example, why would someone risk a back injury when they could use new lift or transfer equipment?
Usually there's a reason that has to do with what is reinforced or rewarded within the organization. For example, it may take more time for a nurse to retrieve the lift equipment, and the nurse may feel that the priority is to respond to the patient quickly and to be productive.
"There are certain consequences that make it easy for us to fail to do the right thing," says Dunn. A solution may be to buy more equipment so it is more readily available, to install ceiling lifts with slings stored in the patient's room, or to expand the patient handling equipment to provide a range of devices, she notes.
You can ensure buy-in and better compliance by including frontline health care workers on committees that will select the new devices, Dunn adds.
Trying to improve compliance by punishing people who don't use the equipment is not a good tactic, she advises. It's better to look for systemic changes that could encourage the behavior change, Dunn says. -
Monitor leading indicators.
Your safety indicators will depend on the goals you have targeted and the priorities you have set. They may include such items as infection rates, patient handling injuries and patient falls.
Those indicators will be a topic on the agenda of board and executive leadership meetings and should be shared with employees, says Newbold. "What you'd like to do is develop leading indicators, things that you can monitor every day or every week," he says. - Create positive role models.
The hospitals leaders are the ultimate role models. Just as an development company's CEO will wear a hard hat on a construction site, the hospital's leaders should be the first volunteering for a flu shot and physicians should set an example in hand hygiene and sharps safety. In short, says Dunn, leadership should "lead with safety."
Meanwhile, employees can be safety role models for each other. VA hospitals use "back injury resource nurses" or BIRNs to encourage co-workers to use lift equipment and to help when an employee is unsure about how to use a device. Some hospitals encourage nurses to remind coworkers even physicians to perform hand hygiene before and after every patient contact.
Those policies help create a culture of safety, says Hidley, who worked with BST co-founder chairman Tom Krause to write Taking the Lead in Patient Safety: How Leaders Create Culture and Influence Behavior (John Wiley & Sons, 2008).
"Often the thing that determines whether the employee does something in a way that's safe or not safe is the culture [of the workplace]," he says.
Creating a culture of safety means more than identifying problems and finding solutions. It requires a shared vision that goes beyond individual instances.
"Health care organizations tend to approach safety at a tactical level, solving one problem after another," says Hidley. "If the leadership started to think of it as a strategic issue and approach it like they would approach other strategic issues, that [change] would have a huge impact. That approach would not be fragmented."
Employee safety is not just a concern for the safety officer or employee health, and it is not distinct from patient safety. In a culture of safety, "patient safety and employee safety would not be in different silos," Hidley says. "It would result in integration across the organization."
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