Healthcare Safety Culture: A Seven-Step Success Framework

In 2016 the total cost burden for patient harm in the U.S. was$146 billion. Of these adverse events,30 to 70 percentwere potentially avoidable, leaving a significant opportunity for healthcare toimprove patient safety. Successful and sustainable patient safety improvement rests heavily on an organizational culture of patient safety, in which leadership supports systemwide attitudes, actions, teamwork, and technology to reduce the risk of patient harm. In an era in which healthcare IT is guiding critical decisions affecting patient safety, health leaders need a sociotechnical improvement framework that addresses culture, process, and technology.

According to a2016 study, an improved safety culture and teamwork can help health systems reduce patient harm across entire hospital systems and multiple harm types. Based on results from theSafety Attitudes Questionnaire(SAQ), as workforce attitudes towards safety improved, all-hospital harm decreased significantly, as did serious safety events.

Organizations that don’t prioritize a safety culture risk the following adverse consequences:

• Underreported safety events.
• 缺乏改善的。
• A higher rate of harm.
• 劳动力倦怠和人员流动。
• Rising costs.

本文描述了安全文化的社会技术框架，在该框架中，员工可以公开共享安全信息并利用医疗保健IT来支持安全目标。这种结构为卫生系统提供了改善患者安全、更好的医疗保健和员工成果以及降低成本的路线图。

Safety Culture: A Blame-Free Environment that Prioritizes Patient Safety

The Patient Safety Network(PSNET) bases its concepts of apatient safety cultureon research in industries outside of healthcare that carry out complex, hazardous work.High reliability organizationsminimize adverse events despite inherent risks in the workplace. In healthcare, high reliability organizations commit to a culture of safety that observes four key features:

1. Acknowledges the high-risk nature of the organization’s activities and commits to consistently safe operations.
2. Supports a blame-free environment, in which individuals can report errors or risks for harm without fear of repercussions.
3. Encourages systemwide collaboration to resolve patient safety problems.
4. 将组织资源用于解决安全问题。

Cultural Challenges to Improving Patient Safety

To establish an effective and sustainable safety culture, healthcare leaders must have strategies and tools to navigate several known cultural challenges:

• Underreportingof safety events—frontline clinicians (particularly those who are not managers or supervisors) do not consistently report safety events because they fear blame and negative repercussions.
• Lack of commitment from seniorleadership—senior leaders may have inadequate commitment to patient safety compared with supervisors and frontline clinicians.
• Inadequateteamworkand communication—caregivers in the operating room have different perceptions of teamwork by role (e.g., surgeons versus nurses), potentially impacting safety coordination efforts.

Seven Ways a Sociotechnical Framework Improves a Safety Culture

As explained above, organizational culture often blocks meaningful improvement or gains in patient safety. To address the cultural challenges of improving safety culture, as well as the process and technology elements that support and sustain a culture of safety, health systems can use asociotechnical framework. Culture includes patient- and family-centered care, leadership, teamwork, frontline staff burnout, and economic impact of culture; process includes organizational fairness, reliability, and process improvement; and technology includes healthcare IT.

图1显示了社会技术方法如何结合文化、过程和技术。阶梯式评分衡量了三个要素，并显示了一个卫生系统在安全文化方面是做得很差(非常低)还是做得很好(非常高)。

A patient safety culture based on sociotechnical framework has seven key strengths:

1. Leverages Qualitative and Quantitative Data (Versus Quantitative Safety Scores Alone)

High quantitative cultural scores at the unit level don’t reflect whether an organization is using healthcare IT safely, or that its healthcare IT systems are safe. To determine if a culture of safety exists among team members or if they have a fundamental understanding of the principles of patient safety and are practicing them, health systems need qualitative data (e.g., focus groups).

2. Doesn’t Rely on HIMSS Stage Levels to Tell theCompleteSafety Picture

TheHIMSS Analytics Electronic Medical Record Adoption Model(EMRAM)对卫生系统的EMR能力进行评分，但这些评分可能与临床安全性不一致。临床单位可以获得HIMSS第5阶段或更高的分数，但根据一线工作人员的定性反馈，仍然可以体验到安全问题。然而，HIMSS水平并不能衡量患者安全和安全问题文化。

3. Gives Frontline Clinicians a Voice in Decision Making

When decision making is relegated to and centralized at healthcare IT higher management levels, frontline caregivers are less able to quickly act on safety issues they identify. With local (versus top-down) oversight, frontline clinicians can address potential harm immediately. Empowering frontline clinicians with patient-specific safety analytics allows for immediate clinical decision making to mitigate or prevent harm.

4. Makes IT Solutions Accessible to Non-Technical Users

Frontline clinicians must be able to easily access and use safety analytics solutions to make timely safety-related decisions. Inefficiencies with technology not only delay addressing safety issues and increases risk, but also create stress for users, which increases the risk for workforce burnout. Organizations can make efficient patient safety solutions accessible to frontline clinicians with a secure, cloud-based software module (e.g., thePatient Safety Monitor™ Suite: Surveillance Module). The Surveillance Module helps detect, monitor, and prevent patient safety events and automates reporting to provide predictivedata and all-harm identification and analysis.

5. Encourages Frontline Clinicians to Report Safety and Quality Issues

With an organizational culture in which frontline staff are comfortable reporting any safety or quality concerns, health systems can more accurately measure safety issues (an essential step in reducing risk). To ensure that staff are comfortable speaking up, leadership must uphold an environment of non-negotiable mutual respect for all team members.

6. Treats a Safety Issue in One Area as a Potential Systemwide Risk

在一个卫生系统单元中出现的与it相关的安全问题可能表明整个系统存在风险。例如，如果急诊科(ED)的所有患者的药物核对表在基本结构上存在错误，并且存在潜在的安全风险，那么它将影响从ED进入卫生系统的每一位患者。通过确定一个单元中可能在整个系统中重复出现的问题(例如，不正确/不准确的协议、自动填充问题和不准确的药物映射)，组织可以降低整个系统的风险。

7. Performs Thorough Due Diligence Before Taking Safety IT Solutions Live

卫生系统要充分利用IT解决方案来改善患者安全，必须在使用这些工具之前进行彻底的尽2022卡塔尔世界杯赛程表时间职调查。当组织在测试基本功能(例如，登录护理模块)之前就启动工具时，就有可能偏离技术和改进目标。

The Sociotechnical Framework: Combining Culture, Process, and Technology to Improve Patient Safety

通过结合定性和定量数据，一个简化的文化、流程和技术的社会技术框架为卫生系统提供了衡量和改善其安全文化的全面指南，包括如何使用医疗保健IT解决方案。2022卡塔尔世界杯赛程表时间通过使用社会技术框架来指导对其安全工作和文化的定期重新评估，组织可以保持安全改进的正轨。

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

1. How to Use Data to Improve Patient Safety
2. Improving Patient Safety: Machine Learning Targets an Urgent Concern
3. Survey Shows the Role of Technology in the Progress of Patient Safety
4. Collaborative, Data-Driven Approach Reduces Sepsis Mortality by 54 Percent