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How to create a "culture of safety"

Patient Safety Monitor Alert, March 17, 2004

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What does it mean to create a "culture of safety?" Certainly, it requires more than being careful and making fewer errors. Staff must feel "safe" to report errors and near misses without fear of punishment or reprisal, writes Suzanne C. Beyea, RN, PhD, FAAN, in the February 2004 issue of the AORN Journal (Association of periOperative Registered Nurses).

 "Most nurses can recall a time when they discovered or were aware of an error but did not report it because they did not want to get a colleague in trouble," Beyea writes.

 Organizations must create a "just" environment in which staff understand why medical errors occur and feel encouraged to report them. Providers and administrators must acknowledge that mistakes will occur if there are underlying system failures, including intimidating behavior by medical staff and others (see "Intimidation endangers patient safety" in this issue of Patient Safety Monitor). 

For example, a periOperative nurse could grab the wrong dose or strength when accessing medication from an automated dispensing device if it includes different doses of the same medication in the same drawer. Environmental and situational factors, such as poor lighting, noise, or interruptions, can also contribute to errors.

In addition, clinicians should examine their own attitudes toward medical errors. Do they blame themselves or colleagues when errors occur? "Each clinician has a responsibility to work toward creating a just safety culture in their practice setting," Beyea states.

Other systems changes that organizations can make in order to encourage a culture of safety include 

• Examining how decisions made by managers, equipment designers, architects, and others contribute to conditions in which errors are likely to occur
• Simplifying tasks and reducing hand-offs,
• Redesigning work processes
• Reducing the need for calculation
• Providing adequate training
• Incorporating human factor design principles in clinical processes
• Decreasing reliance on vigilance and memory
• Developing and enhancing data collection systems

The Institute of Medicine (IOM) made similar recommendations in its November 2003 report, "Keeping Patients Safe: Transforming the Work Environment of Nurses."

Click here to read about the IOM report in Briefings on Patient Safety.

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