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The Culture of Safety Transformation...Leadership's Role

Patient Safety Quality Monthly, March 13, 2008

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Note: This e-newsletter is based on a segment of The Greeley Company seminar Breakthrough to Patient Safety's Next Generation: Moving Beyond Compliance to High Reliability, presented by Ken Rohde, senior consultant, and Robert Marder, MD, vice president of The Greeley Company, at the Palm Springs seminar in January.

In last month's article, Incident Reporting: A Key to Improving Patient Safety, we mentioned that reducing the incidence of medical errors requires the gathering of key information trending outcomes, identifying common causes and apparent causes, and designing quality initiatives to prevent future occurrences. And, for this process to be successful, there needs to be an organizational focus on a culture of patient safety.

This patient safety cultural transformation can only be successful when the organization's leaders are knowledgeable and engaged in the transformation process. The role of leadership is to develop a long-term strategy that includes a vision for tomorrow and clear, actionable, and sustainable goals.

In order for leadership to accomplish this, they need reliable and valid information based on hospital, staff, and physician performance, as well as patient, staff, and physician perceptions of current safety practices.

The first step is to understand what a mature safety and reliability program looks like. The next step is to assess where you stand in relation to that.  Evaluate your facility in the following areas:
 Safety culture and program, including safe behaviors, environment, and supporting structures
 Defined vision and identification of measurable and sustainable safety goals
 Physician engagement, including physician and initiatives to reduce errors and implement systemized approaches to patient care
 Leadership engagement, including the extent to which safety has been identified as a core value and long-term business strategy
 Safe behaviors, such as identifying safety expectations, encouraging a strong reporting culture, and demanding management culpability in supporting safe behaviors
 Reaction to errors by identifying error reporting and reduction as a management strategy, using methods such as common cause and apparent cause analysis to reduce errors, and evaluating corrective actions to measure their effect
 Safe systems processes and equipment, including clear ownership of all processes; process risk assessment (FMEA) for all major changes, such as new services; regular analysis of poor quality using industry-standard tools and methods; and human factors and ergonomic analysis of all key equipment and processes
 Focus on project execution, including leadership expectation measures, organizationwide standardization and prioritization processes, use of formal project management tools and methods, clear integration of actions with overall strategy, and the accountability and culpability of management
 Transition to internally driven safety culture, as measured by the organization's progress in going beyond external requirements to adopting best-practice methods and creating innovative solutions
 ROI measures, such as the capacity to correlate occurrences to financial and risk performance, the cost of poor quality to be considered in major decisions, the recognition of patient and employee safety as a sound investment
 Sustainability benefits realized over time

For more information on the culture of safety assessment and transformation, contact Sharon Courage, MPH, RN at scourage@greeley.com or 888/749-3054, ext. 3501.

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