IMPROVING YOUR CULTURE OF SAFETY
So you work in healthcare, and your organization wants to improve its culture of safety. If safety culture is the sum of what an organization is and does in the pursuit of safety, and is defined by The Joint Commission as “the product of individual and group beliefs, values, attitudes, perceptions, competencies, and patterns of behavior that determine the organization’s commitment to quality and patient safety,” what does it actually look like in practice and how do you measure it?
WHAT IS CULTURE OF SAFETY?
Before we get too far along, what does a culture of safety look like in an organization? Organizations with a positive culture of safety have clearly agreed upon norms of behavior and structures that support safety. Key in the healthcare setting are psychological safety, the ability of anyone to voice a concern about a patient or a practice, support for the reporting of errors and near misses (and open discussion of those events), and fairness and justice in holding both individuals and the organization accountable for their contributions to the error – choices and behaviors on the part of the individual, and systems and processes on the part of the organization.
Research tells us that improving safety culture means fewer adverse events and better outcomes for patients. But before you measure your organization’s culture of safety, a key question must be asked. Do you have an organization that is ready and willing to act upon the findings?
JUST CULTURE IS A FOUNDATIONAL ELEMENT
It all starts with an organization that has embraced a just culture and has made a commitment to look at the interactions between people and systems – without seeking to immediately assign blame. By holding both individuals and the organization accountable, a just culture organization is best poised to take the learnings of incidents, analyze the system’s contribution and introduce preventative measures in a way that will advance cultural transformation in the organization.
BETA Healthcare Group created the BETA HEART® initiative in 2016 as a holistic approach to responding to and reducing harm in healthcare. The purpose of BETA HEART (healing, empathy, accountability, resolution, trust) is to bring about culture change by promoting transparent and open dialogue with patients and their families and foster an ethical approach to medical error that reinforces trust. As part of the multi-year BETA HEART program, member healthcare organizations undertake a survey to learn about themselves and provide a baseline for the work they will undertake in implementing BETA HEART in their organization.
THERE’S A SURVEY FOR THAT!
There are a variety of options for conducting a survey to evaluate safety culture, from open source survey tools, in-house assessments, to surveys purchased and administered by private companies. After extensive research on the topic, BETA partnered with Safe and Reliable Healthcare (SRH) to bring our members the SCOR-E survey via the BETA HEART program. SCOR-E stands for Safety, Culture, Operational Reliability and Engagement. Scientifically validated and psychometrically sound, the survey offers robust analytics and serves as a valuable tool for risk identification and prioritization.
SCOR-E extends beyond measurement to the organizational learning and identification of unit-based defects that not only associates well with the BETA HEART body of work, but also provides us with an instrument that has unique properties that deliver results that are essential to advance dialogue in our member organizations in the form of debriefing – which can be used to drive process improvement and positive cultural change.
SETTING UP FOR A SURVEY
A survey is only as good as the process that surrounds it. While the survey administration itself takes 3-4 weeks, the survey prep and post-survey work will determine the success of the survey in your organization. From executive buy-in and sponsorship, to clearly articulating the purpose and objectives of the survey to staff, to engaging survey champions among management, to holding management accountable for corrective actions based on survey results – all contribute to gaining the 60-80% response rate needed to have a statistically valid results, whether the problem areas identified by the survey are regarded as opportunities for improvement, and whether staff will see the changes based on their input.
DEBRIEFING FOR ORGANIZATIONAL CHANGE
Communicating culture of safety results in a way that will create cultural change begins with dialogue. It has been shown that when leadership openly discusses results and focus on involving employees in the development of action plans, there are higher levels of employee engagement and it creates a climate for a shared understanding of the current culture and where the organization is headed.
DEBRIEFING FRONTLINE STAFF
After debriefing executive leadership, the next step in the debriefing process is to conduct service and/or unit-specific focus groups. BETA takes a different approach with regard to looking at their individual data, sharing the results not just in graph format, but promoting discussion through a deeper dive into the survey data. Leading an open discussion into the “why’s” of both high and low ranked survey items can lead to insights and help determine top priorities that can be mirrored in other units, or that require immediate attention. By brainstorming ideas and possible solutions and having a scribe on hand to document feedback, staff-driven action plans can be developed and implemented.
PLAN THE WORK, WORK THE PLAN
Creating the action plan based on the information gained in the debrief sessions, evaluating and re-evaluating the action plan for progress, and communicating results to staff and other stakeholders at regular intervals, forms a cycle of work that will lead to an improved culture of safety in your organization and reinforce trust.
ABOUT THE AUTHOR
Lisa Matheny, RN, B.S.N., CPHRM, C-EFM is a Director of Risk Management and Patient Safety at BETA Healthcare Group, focused on risk management, quality management, and perinatal patient safety. She is the lead of the culture domain for BETA HEART® and is largely responsible for creating the debrief structure and methodology at BETA, her experience informed by her work at a large multi-entity hospital system where culture surveys were conducted. Previously, she spent 12 years bedside as a registered nurse and clinical supervisor in maternal-infant care and has led multiple perinatal patient safety initiatives. This year, Lisa presented “The Great Debrief: Strategies for Communicating Culture of Safety Survey Results that Create Organizational Change” at the California Society for Healthcare Risk Management (CSHRM) Annual Conference.
BETA Healthcare Group is the largest professional liability insurer of hospitals on the West Coast and provides liability and workers’ compensation coverages to protect hospitals, healthcare facilities, physicians, and other healthcare workers. Its leading-edge patient and employee safety programs provide education, tools and resources that help facilities deliver the best patient care while reducing harm to patients and establishing a safe workplace environment.