Culture of Safety: “First do not harm”
Although healthcare successfully treats and cares for millions of people every day, it remains unacceptably dangerous. Estimates suggest that up to 17% of hospitalized patients experience at least one adverse events of which researches argue that up to 70% could be prevented.
So what to do?
Safer healthcare can be reality for all of us. Accordingly, safety culture can be defined as the organizational culture that directly or indirectly influences safety. Evidences from safety critical sectors including healthcare suggests that good safety culture can help make organizations less vulnerable to incidents and accidents.
The concept of safety culture originated outside health care, in studies of high reliability organizations, organizations that consistently minimize adverse events despite carrying out intrinsically complex and hazardous work.
From public enquiries it has become evident that a broken safety culture is responsible for many of the major process safety disasters that have taken place around the world over the past 20 years or so.
Typical features related to these disasters are where there had been a culture of:
- ‘Profit before safety’, where productivity always came before safety, as safety was viewed as a cost, not an investment.
- ‘Fear’, so that problems remained hidden as they are driven underground by those trying to avoid sanctions or reprimands.
- ‘Ineffective leadership’, where blinkered leadership and the prevailing corporate culture prevented the recognition of risks and opportunities leading to wrong safety decisions being made at the wrong time, for the wrong reasons.
- ‘Non-compliance’ to standards, rules and procedures by managers and the workforce.
- ‘Miscommunication’, where critical safety information had not been relayed to decision-makers and/ or the message had been diluted.
- ‘Competency failures’, where there were false expectations that direct hires and contractors were highly trained and competent.
- Ignoring ‘lessons learned’, where safety critical information was not extracted, shared or enforced.
Improving the culture of safety within health care is an essential component of preventing or reducing errors and improving overall health care quality. Studies have documented considerable variation in perceptions of safety culture across organizations and job descriptions.
Safety culture is also a leading rather than a lagging indicator of safe healthcare, and by assessing and monitoring their safety culture, an organization can see if things are as they should be before they start to go wrong and intervene early if needed.
E. Scott Geller has written of a “total safety culture” (TSC) achieved through implementing applied behavioral techniques.
For safety culture to be successful, it must influence all the members of an organisation. Taking a systematic approach to safety is considered critical in ensuring that the system will provide a continuous cycle of improvement.
- Zegers,M.,et al. Adverse events and potentially, preventable deaths in Dutch hospitals
- CALL, D.O.C., Close Calls in Health Care.The Value of Close Calls in Improving Patient Safety
- Glendon, A. Ian; Clarke, Sharon; McKenna, Eugene (2006). Human Safety and Risk Management, Second Edition (2 ed.). CRC Press. p. 370.
- Geller, E.S. The Psychology of Safety: How to Improve Behaviors and Attitudes on the Job. Boca Raton, FL: CRC Press, 1996.
- Geller, E.S. “Ten Principles for Achieving a Total Safety Culture.” Professional Safety. Sept. 1994: 18-24