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Getting into the Game on Safety Culture

Posted By Administration, Friday, January 22, 2016

Leaders need practical tools to work toward a culture of safety in their organization, and board members need to be more than cheerleaders — they need to be in the game.


By Tejal K. Gandhi, MD, MPH, CPPS

Tejal K. Gandhi


A search of the words “culture of safety” in Google brings more than 9 million results. Not all of these relate to health care, of course; theories about a culture of safety started in other industries. Yet, the abundance of material about a culture of safety is reason enough to wonder why such a culture is so difficult to achieve and sustain in health care organizations.


To understand why, we must first define what we mean. In the new NPSF report Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err Is Human, we use a definition of safety culture that is widely used in health care, which states in part:


Organizations with a positive safety culture are characterized by communications founded on mutual trust, by shared perceptions of the importance of safety, and by confidence in the efficacy of preventive measures (Health and Safety Commission 1993).


A culture of safety provides the means for robust reporting of errors and near misses, as well as the feedback loop to inform staff of what was done to prevent recurrence. It is a learning environment, where adverse events do not get hushed up, but instead are shared throughout the organization to educate all. It is a culture that does not punish human error, but that does address unprofessional and disruptive behavior that can undermine safety. It is a culture where everyone is preoccupied with the possibility of failures and how to prevent them and mitigate harm.


The expert panel members who contributed to the NPSF report cited culture change as the biggest struggle around effecting improvement in patient safety. As others agree, it’s difficult to imagine making long-term progress in patient safety if our culture remains dysfunctional.


In making culture the focus of our number one recommendation, we tied it to leadership, because the leaders and board members of health care organizations hold extraordinary power to impact the culture.


But knowing that, even accepting it, in theory alone is not enough. We need to give our leaders practical tools to use to improve their organization’s culture. And board members need to be more than cheerleaders for this work. They need to be in the game.


Where to begin? Sadly, I would wager that every hospital in the country has an adverse event or near-miss story to tell at least once a month. Why not open every board meeting with a patient story, so board members get a sense of the real people they are serving by being in the room? Why not demand that safety data be reported at every board meeting?


We also call for all board members and leaders of health care organizations to receive education about the fundamentals of patient safety science, just culture principles, and systems thinking. This is really an essential first step toward “shared perceptions of the importance of safety.”


I’ve said many times in recent talks and interviews that we cannot simply tell people: “Go change your culture.” It’s hard work that is never really done. Leaders must prioritize the importance of safety culture and learn strategies to effectively create it.

What tactics are implemented in your organization to encourage a culture of safety? Comment on this post below. Note: To comment, you must first register on the website. If you are already registered, you must log in to comment.

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Tejal K. Gandhi, MD, MPH, CPPS, is president and chief executive officer of the National Patient Safety Foundation and of the NPSF Lucian Leape Institute.

Tags:  culture  leadership 

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