Risk Management and Patient Safety
By James Conway, Chief Operating Officer, Dana Farber Cancer Institute
Overview
Optimal patient safety is more cultural than programmatic; it stems from the organizational mission and is consistent across all interactions the patient has with a health care entity. In the ideal setting, the patient safety culture is deliberate, well-defined, and universally understood. This program can help leaders and individuals within an organization assess the prevailing patient safety culture and work on directing it toward the ideal.
Rationale
The mission of medical care is to improve patient health or, at the very least, prevent avoidable patient harm. Despite these truisms, statistics say hundreds of people are harmed each day in the health care system. The organizational culture underlying attitudes and commitments regarding patient safety are key to instituting and sustaining meaningful improvements. Since an organization's culture is an amalgam of individual attitudes and practices, those individuals and the institution as a whole have an obligation to define and promote the cultural components that make optimal patient safety “the way we do things here.”
Inquiry
Is your organization safe for you and your patients? What makes it safe, or unsafe?
Even if you cannot document it, you know the answer. Even in their first few days, your new colleagues will get a sense of where this workplace falls on the safety spectrum. Even the sickest patients will observe it. And even in the safest settings, it can always be pushed toward improvement.
The institutional attitude toward patient safety—and toward improving patient safety—is often called the “culture of safety.” Most organizations are striving to improve patient safety, to move toward an optimal culture of safety. Such goals are not easily achieved, they cannot be achieved by mandate. Even the best designed safety programs have to work within the local culture.
What is the local culture? Simply put, organizational culture is “the way we do things here.” It is the combination of institutional history, leadership, budget reality, and staff experience: the underlying sense of appropriate behavior and practice that prevails throughout the workplace. It is what helps you decide:
- Should I listen to this patient for five more minutes or keep on schedule?
- Who do I tell about what just happened?
A health care organization's culture of safety is a subset of the overall organizational culture. The triumph of patient safety improvement initiatives is directly linked to that culture. Getting clinicians who don't like meetings to show up for safety-related meetings means you are attempting to change the culture. Asking the time-pressed OR staff to take three minutes for pre-procedure briefings is attempting to change the culture. Extolling residents used to being told to “figure it out yourself” to call their supervisor whenever they're unsure is attempting to change the culture.
Summary
Successful patient safety improvement efforts always need to have one foot in the way things are and the other foot in the way you want them to be. Ignoring the existing culture will doom virtually any new idea. Postponing improvements because “nothing will ever change” is a self-fulfilling prophecy. Introducing change in alignment with the current culture can bring about significant patient safety improvement.
- Step one is assessing the current culture.
- Step two is determining the basic components of an optimal culture of safety for your workplace. What do you and your colleagues want patients and caregivers to see, hear, smell, and feel as they move through the health care process.
- Step three is figuring out who can lead your organization to that goal.
- Step four is to start making improvements.
- Step five is to ask yourself again: Is this organization safe for me and our patients? What makes it safe, or unsafe?