Does your facility have a patient-safe’ climate?

How to measure factors that affect patient safety

By Patrice Spath, RHIT

Brown-Spath Associates

Forest Grove, OR

The culture of a health care organization significantly affects the safety of patients that are treated in the facility. Culture refers to the philosophy of senior leaders that translates into and affects the behaviors of people who work in the organization. The level of patient safety in a health care organization is a product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior. For example, if people believe it is acceptable behavior to "take risks," this thinking has a strong influence on an individual’s willingness to take short cuts in their job. People may act without giving the risk-taking behavior any thought.

When the work culture does not promote a patient-safe environment, it is more likely that human errors will occur. A higher human error rate means more adverse patient incidents. Work culture is formed by the work force over time based on its perception and acceptance of the behavior standards. The behavior standards are established by senior management either through operating guidance or through supervisory reinforcement.

Technically, it is very difficult to measure the culture of a health care organization. What can be measured are the factors that affect patient safety: management systems, safety systems, and individual attitudes and perceptions about patient safety improvement.

Factors found in patient-safe cultures

The level of patient safety is influenced by the management system within a health care organization. Senior leaders must create a positive safety culture. In health care organizations with adequate leadership involvement, one would find clearly communicated patient safety expectations, facilitywide patient safety policies, and improvement goals. There are well-defined expectations for removing or controlling identified patient safety hazards, and these expectations are translated into performance requirements for management and staff. Most important, the leaders’ commitment to patient safety is visible to physicians and staff. Otherwise, for all intents and purposes, if the commitment is not visible to people, it may as well be nonexistent!

Safety systems refer to the mechanisms that contribute to patient safety, such as periodic hazard review of high-risk patient care processes, collection and analysis of patient incident data, and routine investigation of significant adverse events. In a patient-safe climate, there are systematic methods for finding and eliminating the error-producing factors in patient care activities, and everyone knows how safety is measured and what must be done to reduce the risk of medical accidents. Another component of the safety system is training. In a patient-safe health care environment, people are adequately trained to perform their assigned responsibilities.

The third factor in a patient-safe culture relates to individual motivation. People must not only feel a duty to protect patients from harm; they must feel free to speak up when patient safety is being jeopardized. They must be on the alert for risky situations and be empowered to take whatever action is necessary to prevent an adverse event. In a patient-safe environment, people are rewarded for their involvement in patient safety improvement.

Staff turnover can promote increase in errors

The following dynamics, some of which are now present in health care organizations, have been known to turn a formerly patient-safe work culture into an error-prone climate:

• a large reduction (or turnover) in work force;

• strong emphasis on profits, ignoring quality standards;

• reduction in staff behavior standards due to failure to reinforce;

• retirement of experienced supervisors and managers.

Use the checklist accompanying this article to determine how many of the elements of a patient-safe culture are present in your organization. (See checklist, p. 82.) The elements on the list cover the three factors influencing how patient-safe an organization’s culture is: management systems, safety systems, and individual attitudes and perceptions about patient safety improvement. If you find that many of the elements are missing in your organization, consider following up with more extensive interviews with a representative sample of the work force. These interviews will help you thoroughly judge the severity and spread of culture problems that affect patient safety.

If your organization lacks many of the elements that contribute to a patient-safe environment, it’s time to take action. Unless there is a concerted effort to intervene and improve the climate in health care organizations, the human error rate will remain steady — or worse yet, it will climb. The higher the human error rate, the higher the rate of medical accidents.

Three steps are usually needed to turn around a work culture that does not support the patient-safe environment that you want in your health care organization:

1. Understand the severity and spread of the cultural issues that are affecting the safety of patients.

2. Determine which critical element of the work culture affects future patient incident rates, and concentrate change efforts on these elements.

3. Initiate rapid patient safety improvement intervention through retraining and accountability.

The culture of a health care organization must support all factors of patient safety, including the leadership components. Meeting this challenge may mean your organization needs a major shift in attitudes and the ways in which patient safety is measured and improved.