Culture of Safety John Morley, MD Chief Medical Officer Jacobi Medical Center & North Central Bronx...
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Culture of Safety
John Morley, MDChief Medical Officer
Jacobi Medical Center & North Central BronxNYC Health & Hospitals
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Friday, March 11, 2011 @ 05:46 UTC
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July 6, 2013 @ 11:28 PDT
http://www.ntsb.gov/news/events/Pages/2014_Asiana_BMG-Abstract.aspx
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http://www.bbc.com/news/uk-england-stoke-staffordshire-20965469
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So…
• What do a University scandal, a Tsunami with a Level 7 nuclear accident, a plane crash and hospital scandal all have in common?
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Culture- A set of common, unspoken and assumed
values that drive decision making in an organization or unit.
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What is Culture?
It is NOT -
• A Mission or a Vision statement
• A set of ideals or the wishes of the CEO or executive leadership
• Insignificant
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“Culture”
Professors Ken Thompson (DePaul) and Fred Luthans (Nebraska) identify seven characteristics of culture:
Culture = Behavior
Culture is defined & determined by values But not just any values!
Culture is Learned Through Interaction
Sub-cultures Form Through Rewards
People Shape the Culture
Culture is Negotiated (priorities are negotiated)
Culture is Difficult to Change
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What is Culture?• It is Actions!! It is behaviors!!
• I have always thought the actions of men the best interpreters of their thoughts. — John Locke
• Well done is better than well said. — Benjamin Franklin
• Remember, people will judge you by your actions, not your intentions. You may have a heart of gold — but so does a hard-boiled egg. — Author Unknown
• Ironically, making a statement with words is the least effective method. — Grey Livingston
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What is Culture?
• We are all inclined to judge ourselves by our ideals; others, by their acts. — Harold Nicolson
• When deeds speak, words are nothing. — African Proverb
• I grow older I pay less attention to what men say. I just watch what they do. — Andrew Carnegie
• People may doubt what you say, but they will believe what you do. — Lewis Cass
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http://media.pennlive.com/midstate_impact/other/REPORT_FINAL_071212.pdf
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http://usatoday30.usatoday.com/news/nation/story/2012-07-12/louis-freeh-report-penn-state-jerry-sandusky/56181956/1
http://i.usatoday.net/news/nation/2012-07-12-penn-state-freeh-report.pdf
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http://www.nirs.org/fukushima/naiic_report.pdf
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20http://www.reuters.com/article/2014/02/10/us-asiana-culture-idUSBREA1906U20140210
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https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/226703/Berwick_Report.pdf
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http://www.youtube.com/watch?v=5CcLIPaUz3E
http://www.youtube.com/watch?v=AbFIPc34AJ8
A winning culture at Zappos
https://www.youtube.com/watch?v=cQLTQAv5JQA
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“Safety Culture”• First used in INSAG’s (1988) ‘Summary Report on
the Post-Accident Review Meeting on the Chernobyl Accident’ where safety culture was described as: “That assembly of characteristics and attitudes in organizations and individuals which establishes that, as an overriding priority, nuclear plant safety issues receive the attention warranted by their significance.”
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http://pbadupws.nrc.gov/docs/ML1208/ML120810464.pdf
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So what do we know about our culture?
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30http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/resources/hospscanform.pdf
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Areas of Strength for Most HospitalsThe four areas with the highest % positive responses:1. Teamwork Within Units (average 80% positive
response)2. Supervisor/Manager Expectations and Actions
Promoting Pt. Safety (average 75% positive response)3. Organizational Learning—Continuous Improvement
(average 72% positive response)4. Management Support for Patient Safety (average 72%
positive response)
http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/2012/hosp12summ.html
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Areas With Potential for Improvement for Most Hospitals
Three areas showed potential for improvement:
1. Non-punitive Response to Error (average 44% positive response)
2. Handoffs and Transitions (average 45% positive response)
3. Staffing (average 56% positive response)
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What is it that defines YOUR culture?
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Loyal
Honesty
Dependable
Committed
Open minded
Committed
Transparency
Quality
Safety
Creative
Innovative
Respect
$Revenue$
Courageous
Efficient
Effective
Patient/Family Centered
Effective
Equitable
Timely
Values
Consistent/ HRO
Compassion
Speaking up
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• Dependable• Revenue• Loyal• Quality• Committed• Open-minded• Consistent• Honest• Efficient• Innovative• Creative• Humorous• Fun-loving• Motivated• Honesty• Transparency
• Positive• Honesty• Optimistic• Inspiring• Passionate• Respectful• Athletic• Fit• Courageous• Educated• Respected• Loving • Nurturing• Adventurous
Mt. Saint Everywhere General
Safe, Effective, Efficient, Timely, Family Centered and Equitable
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1. Revenue2. Dependable3. Loyal4. Committed5. Open-minded6. Consistent7. Honest8. Efficient9. Innovative10. Creative11. Humorous12. Fun-loving13. Motivated14. Honest15. Positive
16. Optimistic17. Inspiring18. Passionate19. Respectful20. Athletic21. Healthy employees22. Courageous23. Educated24. Respected25. Loving 26. Nurturing27. Adventurous28. Transparency29. Quality 30. Safety
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1. Football2. Revenue3. Football4. Committed5. Open-minded6. Academics7. Football8. Efficient9. Innovative10. Football11. Honest12. Fun-loving13. Motivated14. Football15. Positive
16. Optimistic17. Inspiring18. Passionate about football19. Respectful20. Athletic21. Healthy employees22. Courageous23. Educated24. Respected25. Loving 26. Nurturing27. Adventurous28. Transparency29. Quality 30. Safety
Penn State
Protection of children
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1. Safety2. Quality3. Transparency4. Speaking up5. Dependable6. Reliable7. Loyal8. Committed9. Open-minded10. Consistent11. Honest12. Efficient13. Innovative14. Creative15. Humorous
16. Fun-loving17. Motivated18. Honest19. Positive20. Optimistic21. Inspiring22. Passionate23. Respectful24. Healthy employees25. Courageous26. Educated27. Respected28. Loving 29. Nurturing30. Adventurous
Your hospital
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http://www.nejm.org/doi/pdf/10.1056/NEJMp0801863
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http://onlinelibrary.wiley.com/doi/10.1002/jhm.2092/abstract
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High Reliability Organizations
This mindset is supported by five characteristic ways of thinking: • preoccupation with failure• reluctance to simplify explanations for
operations, successes, and failures• sensitivity to operations (situation awareness)• deference to frontline expertise• commitment to resilience
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https://psnet.ahrq.gov/primers/primer/31
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1. Safety2. Quality3. Transparency4. Dependable5. Reliable6. Loyal7. Committed8. Open-minded9. Consistent10. Honest11. Efficient12. Innovative13. Creative14. Humorous15. Fun-loving
16. Motivated17. Honest18. Positive19. Optimistic20. Inspiring21. Passionate22. Respectful23. Athletic24. Healthy employees25. Courageous26. Educated27. Respected28. Loving 29. Nurturing30. Adventurous
Your hospital
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In the beginning was the Plan. . .
• In the beginning was the Plan.And then came the Assumptions.And the Assumptions were without form.And the Plan was without substance.And darkness was upon the face of the Workers.
• And the Workers spoke among themselves, saying, "This is a crock…and it stinks."
• And the Workers went unto their Supervisors and said, "It is a pail of dung, and we can't live with the smell."
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In the beginning was the Plan. . .
• And the Supervisors went unto their Managers, saying, "It is a container of excrement, and it is very strong, such that none may abide by it.“
• And the Managers went unto their Directors, saying, "It is a vessel of fertilizer, and none may abide its strength."
• And the Directors spoke among themselves, saying to one another, "It contains that which aids plant growth, and it is very strong."
• And the Directors went to the Vice Presidents, saying unto them, "It promotes growth, and it is very powerful."
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In the beginning was the Plan. . .
• And the Vice Presidents went to the President, saying unto him, "This new plan will actively promote the growth and vigor of the company with very powerful effects."
• And the President looked upon the Plan and saw that it was good.
• And the Plan became Policy.• And that, my friends, is how …it Happens.
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Culture of Safety
• Even if you are not defining the institutional culture, you are part of a unit and a shift and you are a part of defining that culture.
• The only way to know your culture is to be a part of it. Get out there and lead.
• Be a part of making your culture a Culture of Safety or even better a HRO
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If I have seen further it is by standing on ye shoulders of Giants.
— Sir Isaac Newton