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Patient Safety Culture听

Culture refers to shared values (what is important) and beliefs (what is held to be true) that interact with a system鈥檚 structures and control mechanisms to produce behavioural norms.听 It influences patient safety directly by determining accepted practices and indirectly by acting as a barrier or enabler to the adoption of behaviours that promote patient safety.听 Understanding the components and influencers of culture and assessing the safety culture is essential to developing strategies that creates a culture committed to providing the safest possible care for patients.听

Recommended strategies听

Understand patient safety culture and its components.听

• Recognize that patient safety culture is multi-dimensional consisting of a number of features:听
  • informed culture 鈥� relevant safety information is collected, analyzed and actively disseminated听
  • reporting culture 鈥� an atmosphere where people have the confidence and feel safe to report safety concerns without fear of blame, and they trust that concerns will be acted upon听
  • learning culture 鈥� preventable patient safety incidents are seen as opportunities for learning and changes are made as a result听
  • just culture 鈥� the importance of fairly balancing an understanding system failure with professional accountability听
  • flexible culture 鈥� people are capable of adapting effectively to changing demands听
• Understand how culture influences patient safety outcomes directly by determining accepted norms and practices and indirectly by acting as a barrier or enabler to the adoption of interventions designed to promote patient safety听
• Appreciate the between people, system and culture and how focusing on system improvement and learning, rather than individual performance, drives actions that support patient safety and incident management听

Understand key contributors to a patient safety culture.听

• Appreciate and understand patient safety culture鈥檚 multiple influencers, including:听
  • leadership and board commitment and ongoing visibility (at the organization and team levels)听
  • patient/family engagement听
  • effectiveness and openness of teamwork and communication听
  • of all team members, including patients/families, in reporting problems and incidents measurement/monitoring and learning from safety and incidents听
  • organizational learning听
  • organizational resources for patient safety听
  • priority of safety versus production听
• Provide education, training and resources so that everyone is aware of the critical role of culture in patient safety and what they can do to support it听

Assess patient safety culture.听

• Determine the best methods and tools to patient safety culture in the organization, engaging safety and measurement experts whenever possible听
• Consider assessing both perceptual indicators (front line staff provide majority of data)听 and organizational indicators of culture (senior leaders provide majority of data)听听听
• Obtain informed leadership support for the use of patient safety culture measurement tools to ensure an understanding of the resources required, the barriers that may be encountered, and the potential outcomes听
• caregivers in the planning and implementation of the culture measurement initiative听
• Analyze the results and identify opportunities for improvement, mapping to the various patient safety dimensions and influencers听
• Communicate the results to key stakeholders in a meaningful way including a timeline for next steps and how improvement actions will be identified听
• Understand that patient safety culture measurement is a snapshot in time and that ongoing measurement will be needed to monitor progress听

Develop and implement a patient safety culture strategy.听

• Based on the assessment results and environmental factors and with leadership support develop a shared vision and for improving patient safety culture听听听
• Identify potential opportunities to implement the plan as well as barriers along with corresponding mitigating strategies听
• Address patient safety culture gaps and weaknesses at the organizational and unit/program/service (micro-system) level recognizing that in the same organization culture can be different across units and even between shifts听
• and families in patient safety听
  • empower them to be active participants in their care by encouraging them to speak up, participate in shared decision-making and the development of personalized care plans听
  • engage them in the design of care models, care processes and quality improvement/patient safety initiatives听
• in patient safety听
  • develop multiple strategies that empower staff at all levels to share their concerns and speak up (e.g. anonymous incident reporting system, team training that addresses the authority gradient, safety huddles, anonymous email or telephone 鈥渉ot line鈥� where staff can share concerns)听
  • engage staff in all phases of quality improvement and patient safety initiatives to leverage their expertise听
  • a successful patient safety strategy leads to frontline ownership of local issues and challenges and enables clinicians and providers to action their own solutions听
  • design communication systems that allow for a continuous patient safety conversation between frontline staff and leaders听