Developing a Culture of Healthcare Safety Requires Multifaceted Approach
Improving the safety culture of a hospital or health system will require tackling challenges on several levels of the organizational structure. The culture of blame must be eliminated.
• Create an environment that encourages learning.
• Define the culture of safety.
• Establish ambassadors who can promote the culture of safety.
Strengthening safety culture remains one of the greatest challenges faced by healthcare organizations, where the demanding environment makes it critical to have high-performing teams. There are specific ways to start building a safety culture by introducing a transformational culture shift, says Tanya Fish, employee experience strategy advisor with ITA Group, a consulting company based in West Des Moines.
Healthcare leaders will face challenges creating high-performing teams and a safe healthcare experience, including staff shortages, work hours, workloads, and staffing ratios that affect patient safety, she says. Lack of staff engagement, staff burnout, rapidly changing work environments, and a culture of blame also can complicate the effort.
Risk managers are increasingly pressured to reduce potentially preventable events (PPEs), which requires a multifaceted effort, Fish says. Gaining buy-in to quality improvement initiatives starts with building a partnership between leadership and the workforce, she says.
Healthcare leadership should strive to improve not only the lives of the patients but also the lives of the care teams, Fish says. This builds confidence that the health system can be trusted to deliver on its promises, act with integrity, and treat all fairly. It also leads to a pride in the quality improvements and a workplace the team can be passionate about, she says.
“Identify and articulate clearly how quality improvement initiatives will improve things that matter to the team, such as freeing up time, making their jobs easier, and delivering safer, better patient care,” Fish says. “When launching the initiative, tell stories about how the initiative has led to improvements important to the internal team to emotionally connect with them. While leadership cares about the metrics behind the initiative, the team needs to hear how it aligns to what they care about.”
Fish recommends recognizing and rewarding early adopters for behaviors that will drive success of the program. This extrinsic form of motivation will reinforce actions that will drive success, she says.
“To intrinsically motivate and sustain that behavior, consider making people who demonstrate alignment to the initiative ambassadors. Elevate them through communicating to them more often, have them track their department’s key metrics, and involve them in future decisions,” she says. “By offering both extrinsic and intrinsic forms of motivation, you can engage both short-term for adoption and long-term for sustainability.”
With regard to reducing PPEs, Fish advises focusing on these factors:
• Learning environment: In psychologically safe environments, people are willing to offer up ideas, questions, and concerns, Fish says. They are even willing to fail and to learn from those experiences, she says.
“In studying some of the highest performing teams at Google and Toyota, they have found that process guidelines are important, but more important is that people frame every problem as a learning opportunity, where success is dependent on people taking risks and being vulnerable in front of their peers,” Fish says.
• Employee engagement: Morale can be related to nurse engagement — the dedication they have for their job and how effective they are. Employees who are present, focused, happy, and healthy are more likely to bring positive energy to the team and to the patient experience, while also having a willingness to take on daily challenges, Fish says.
• Open communication: To allow people to perform at their best, it is critical to remove fear from the organization by using open and honest communication, Fish says.
• Teamwork and respect for others: Two of the central tenets of a safe culture — teamwork across disciplines and a blame-free environment for discussing safety issues — are directly threatened by disruptive behavior.
To encourage learning, employees cannot fear being belittled or marginalized when they disagree with peers or authority figures, ask naive questions, own up to mistakes, or present a minority viewpoint, Fish says. Instead, they must be comfortable expressing their thoughts about the work at hand.
The risk manager seeking to improve the culture of safety must tread carefully because today’s healthcare workers are already stressed with multiple safety and quality improvement concerns, Fish says.
Education about safety culture is characterized by shared core values and goals, nonpunitive responses to adverse events and errors, and promotion of safety through education and training, she says.
“A safety culture requires strong, committed leadership, along with the engagement and empowerment of all employees,” Fish says.
Fish offers the following five tips for engaging and empowering employees to improve the culture of safety:
• Define your culture of safety, recognition, and engagement by communicating your culture story and creating a movement within your organization that reminds employees every day why their acts of safety are important and why they love to work for your organization.
• Establish ambassadors to advocate a safety culture. Position them as leaders in the organization who will promote safety and listen to the voices of employees on the topic.
• Provide training and education on acts of safety, including interprofessional communication and collaboration (particularly important in transitions in care and hand-offs), with recognition and rewards for completion and competency.
• Recognize and reward real-time behaviors of teamwork, collaboration, open communication, and accountability so individuals depend on each other and feel secure and supported in sharing their feedback in day-to-day work.
“When you show you value these things, people will gain comfort in using their voices and collaborating more openly,” Fish says. “Better yet, give your people the ability to reward each other — not just top-down recognition — for acts tied to safety, from proper lifting form to open team collaboration about an issue.”
• Communicate key metrics related to the success of your people and organization as they relate to safety. When people can see their progress toward personal and organizationwide goals, they will stay engaged and motivated.
To build a safety culture with high-performing teams, Fish says, risk managers should focus on the healthcare professionals rather than policies and procedures.
“Who is on a team matters less than how the team members interact, structure their work, and view their contributions. Your people are more than just who they are during their shift, and the success of your culture is directly linked to the emphasis you put on your people,” Fish says.
“Give them the ability and autonomy to succeed and the benefits they crave, and you’ll get a boost in individual performance, engagement, and motivation,” she says.
“Ignite passion in your people and transform your culture to engage, motivate, and future-proof your organization.”
• Tanya Fish, Employee Experience Strategy Advisor, ITA Group, West Des Moines. Email: [email protected].
Improving the safety culture of a hospital or health system will require tackling challenges on several levels of the organizational structure.
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