A culture of safety: BPIR.com advice concerning healthcare safely management.

March 8, 2010 by

Significant rewards can be returned when attention is given to both patient safety and health care worker safety. Thomas Krause and John Hidley, executives of U.S. Behavioural Science Technology Inc., write [1] that patient safety and employee safety are inseparable since both are the products of an organisation’s culture. Krause & Hidley suggest the following five ways of thinking in regard to patient/employee safety:

1. Think leadership: when optimising health care safety performance it is essential to begin with leadership i.e. the board of directors, physician leaders, and the health care system leaders, including the CEO and his/her direct reports. When patient and employee safety improves so too does employee satisfaction; organisational citizenship; patient satisfaction; quality of care; malpractice costs decrease, and the overall reputation/financial security of an institution will likewise improve.

2. Think systems: patient and employee safety should focus upon systems performance to a greater extent than individual performance. In practice adverse events arise mostly from complex processes that are embedded within an organisation. Root-cause analysis of incidents shows clearly that, while individuals are often blamed, the real cause of incidents is almost always a failure of systems. The responsibility for providing adequate systems belongs to the leadership of the organisation.

3. Think strategy: an overarching strategy must be used to significantly improve patient safety. Too often, safety comes after efficiency, after economy and after profit. In professional group meetings or in board meetings, safety is often very low on the agenda, if it is there at all. Safety must command a central position of strategic value to organisational leadership at all levels.

4. Think culture: leaders create culture with their every thought, word and deed. Leadership predicts culture, and culture predicts safety outcomes. Krause and Hidley state that “since leadership shapes culture, and culture predictably defines the likelihood of exposure to harm, leaders are obligated to take action consciously and continually to mitigate hazard.” A fundamental ethical error in regard to patient safety is committed when leaders know how to minimize exposure to harm but don't take any action to make this happen.

5. Think behaviour:
learn to think about patient safety in terms of behaviour – particularly one’s own behaviour. Effective safety leadership involves finding the specific relationship between ones actions as a leader and the state of patient safety, both organisation wide, and within local functional areas of responsibility. Once this relationship is understood then it becomes possible to change behaviour to everyone's benefit.

[1] R10854 Krause T. R., Hidley, J. H., (2008), Five Ways to Think About Patient Safety, Trustee, Vol 61, Iss 10, pp 24-27, Health Forum Inc., Chicago

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Neil Crawford
BPIR.com

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