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Culture Change on the Agenda

Posted By Administration, Friday, September 30, 2016

Dana Siegal, RN, CPHRM, prompts attendees to think
30 years into the future and imagine how
health care culture has changed for the better.

The 9th Annual NPSF Lucian Leape Institute Forum & Keynote Dinner focused on safety culture, leadership, and strategies for the real world.

by Patricia McTiernan, MS

Imagine it is 2046. What changes will have taken place to improve the safety of patients and the health care workforce? What would you like to see happen over the next 30 years—and what are you willing to do to make it a reality?

Those were among the questions posed to attendees of the 9th annual NPSF Lucian Leape Institute Forum & Keynote Dinner held in Boston on September 15. Dana Siegal, RN, CPHRM, CPPS, director of patient safety services, CRICO Strategies, led an afternoon session punctuated by skits illustrating one dramatic change in health care culture over the years: the move to tobacco-free health care organizations.

Ms. Siegal recounted how, 30 years ago when she was a new nurse, smoking in hospitals was not uncommon among doctors, nurses, and even patients (unless on oxygen, of course!). Slowly, things began to change; smoking was confined to the “back room,” then to the outdoors. And finally, not all that long ago, tobacco was largely banned from the grounds of most hospitals, including parking lots.

What does smoking have to do with patient safety? The point Ms. Siegal hit upon is that culture change does not happen overnight. It takes time, sometimes a very long time, for norms and attitudes to spread throughout an organization, a community, a region, an industry, and in this case, across the country. She invited attendees to share their wishes for what health care and patient safety would look like in 30 years.


Here are just a few:



What would you want to see happen over the next 30 years?

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Looking Forward: New Models of Safety and Risk

The afternoon keynote speaker, renowned patient safety researcher Charles Vincent, PhD, MPhil, gave attendees a glimpse of what the future might look like.

    Charles Vincent 
     Prof. Charles Vincent provided an overview of new models
of assessing risk and promoting safety in health care.

Currently Emeritus Professor, Clinical Safety Research, at Imperial College, London, Prof. Vincent has an extensive background in research on the causes of harm to patients, consequences for patients and staff, and methods of improving the safety of health care. His most recent book, Safer Healthcare: Strategies for the Real World (co-authored with René Amalberti) is available at no charge as an e-book (download at

Prof. Vincent’s talk centered on the question of whether it is possible to develop a framework or menu of interventions around patient safety, rather than addressing issues by project or outcome. He noted the correlation to a recent NPSF report calling for an overarching shift from piecemeal approaches to total systems safety.

Prof. Vincent hypothesizes that a framework of strategies and interventions could be applicable across all settings (hospital, home, primary care) and across all levels of care (frontline, organizational, regulatory, and patient self-care). He outlined three models of safety:

  • Avoiding risk (ultra-safe): Examples from outside of health care include the airline industry. This model is characterized by a tough regulatory system and the need to avoid risk as much as possible.
  • Managing risk (high reliability): Risk is not sought out, but is inherent in the work, for example, firefighting. This model is marked by group intelligence and adaptation, with training and safety focused on flexibility and personal resilience being a key component.
  • Embracing risk (ultra-adaptive): An apt example here is deep-sea fishing, where risk is the essence of the profession. Working conditions are unstable and unpredictable.

While some areas of health care may fall into the ultra-safe category, where the goal is to avoid risk altogether, other areas may be categorized by the need to manage or mitigate risk.

Another example Prof. Vincent offered to illustrate the point is home dialysis. Patients and families performing dialysis in the home are trained in how to do it and in safety practices. But they are also schooled in what to do if something goes wrong, which Prof. Vincent said works better than drilling in to people that they have to do things perfectly every time.

“Absolute safety is not the aim,” he said. “We know it is never going to be safe; we need to manage the risk.”

Looking Back to Make Advances

    Dr. Pamela Cipriano, president of the American Nurses
Association, discussed the need to assess the impact and
success of patient safety initiatives.


During the evening keynote address, Pamela Cipriano, PhD, RN, NEA-BC, FAAN, president of the American Nurses Association, noted that those in attendance are already on board with the need to make patient safety the priority. “You’re all converted,” she said. “We can be zealots. The people who are missing haven’t gotten the message.”

Quoting Max DePree, Dr. Cipriano noted that, “When we talk about patient safety, the leader is the servant.” Leaders of health care organizations are the key to setting the bar for safety in their organizations, but not all health care leaders are aligned with the principles that are so important to patient safety.

Dr. Cipriano also cautioned that unintended consequences can result from aggressive agendas. “We don’t always go back and look at the impact” of initiatives, she said.

She offered the example of the practice of isolating patients with Methicillin-resistant Staphylococcus aureus (MRSA) and using contact precautions (gloves and gowns). For years, clinicians and regulators supported the practice of implementing contact precautions of patients found to have MRSA. This process was mandated in a number of states. In 2015, a study argued that the benefits of contact precautions had not been proven, no study had directly compared the effectiveness of contact precautions to standard precautions, even as we know that the use of contact precautions has deleterious effects (psychological and otherwise) on patients. As a result, some hospitals are now moving away from the use of contact precautions and isolation for patients with MRSA.

Excelling in patient safety requires that practices, protocols, and initiatives get reviewed and, if necessary, revised over time. Or, as Prof. Vincent notes in his book, patient safety is "a moving target." “In a very real sense innovation and improving standards create new forms of harm in that there are new ways the healthcare system can fail patients,” he writes.


So, we zealots have work to do.

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What would you like to see change about safety culture in health care? Comment on this post below. Note: to post a comment you must be logged in. Register or log in.

Patricia McTiernan, MS is assistant vice president for communications at the National Patient Safety Foundation and editor of the P.S. Blog. Contact her at

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Tags:  culture  leadership  Leape 

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