Loughborough Design School Is It Raining Out There? An exploration of culture, climate and safety....

Loughborough Design School

Is It Raining Out There?

An exploration of culture, climate and safety.

Dr Mike Fray


Overview

Culture and Climate

Safety I and Safety II

Resilience

Indicators for improvements


Few phrases occur more frequently in discussions about hazardous technologies than safety culture. Few things are so sought after and so little understood

James Reason, 1997


Exploring socio-technical systems approach

Delivery of healthcare services via complex integrated systems

Systems Models: SEIPS 1.0 and SEIPS 2.0 (Carayon et al 2014),

Dial F Model (Hignett 2013),

Dynamic risk and safe performance (Rasmussen1997)

Consider: Role or absence of patient (Mitchell et al 2014)

Active vs passive Compliant vs non-compliant Treatment or rehabilitation (Boltz et al, 2012)


Culture is:

Emerges through a social process Staff attach meaning to policy, practice and behaviour Values, beliefs, assumptions Created through story, myth and ‘believed success’ Is interpretive

Waterson, 2014, Healthcare Foundation, 2013

5


Climate is:

Right here right now. Measureable, observed Process, practice and behaviour Influenced by organisational culture Influenced by organisational procedures Influenced by individuals at the coal face

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Characteristics of a Safe Culture

Managers engage with safety Regular clear information on safety Can raise concerns and will be listened to Safety is always a top priority Investigates all accidents and incidents

HSE 2002

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Characteristics of a Safe Culture

Equipment and training is available if required

Everyone is involved in decision making Rare for people to take short cuts Honest and open about safety Morale is generally high

HSE 2002

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Consider these items against your organisation in healthcare, social care, education, community care?

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Characteristics of a Safe Culture(For Patient Handling) Managers engage with safety (???) Regular clear information on safety Can raise concerns and will be listened to (???) Safety is always a top priority (Against all other priorities) Investigates all accidents and incidents Equipment and training is available if required Everyone is involved in decision making Rare for people to take short cuts(???!) Honest and open about safety Morale is generally high(?)

HSE 2002

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Patient Handling Safety Performance

TROPHI(Fray and Hignett, 2013)

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Outcome Rank

Safety culture 12

MS health measures 11

Competence compliance 10

Absence or staff health 9

Quality of care 8

Accident numbers 7

Psychological well being 6

Patient condition 5

Patient perception 4

MSD exposure measures 3

Patient injuries 2

Financial 1


Culture to Climate

Organisational behaviour measures

(1)

Measures of safe or quality

behaviour (3,5,6)

Measures of effects on individuals

(2,4,7,8,9,10,11)

Financial outcomes

(12)


Are we measuring Culture? Fray Waterson Munro (in press)

Sextons Safety Culture Tool (SAQ) Vs TROPHI (IHI 2012)

OM SCM SCScore % +ve

TROPHI Total 0.50 0.20 0.20 0.20

1 Safety Climate 0.90** 0.70 0.70 0.70

2 MS Health Measure 0.60 0.70 0.70 0.70

3 Competence & Compliance 0.10 0.00 0.00 0.00

5 Quality of Care -0.21 -0.10 -0.10 -0.10

7 Psychological well-being 0.60 0.70 0.70 0.70

8 Patient Condition 0.90** 0.70 0.70 0.70

9 Patient Perception -0.20 -0.60 -0.60 -0.60

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Are we measuring Culture? Fray Waterson Munro (in press)

Sextons Safety Culture Tool (SAQ) Vs TROPHI (ICH 2012)

OM SCM SCScore % +ve

TROPHI Total 0.50 0.20 0.20 0.20

1 Safety Climate 0.90** 0.70 0.70 0.70

2 MS Health Measure 0.60 0.70 0.70 0.70

3 Competence & Compliance 0.10 0.00 0.00 0.00

5 Quality of Care -0.21 -0.10 -0.10 -0.10

7 Psychological well-being 0.60 0.70 0.70 0.70

8 Patient Condition 0.90** 0.70 0.70 0.70

9 Patient Perception -0.20 -0.60 -0.60 -0.60

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Options to consider

Paper systems vs actual practice Management Commitment Work as perceived vs work as done

What makes a successful transfer How do we measure the outcomes of safe patient

handling

Are we creating positives or avoiding negatives?

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Accidents vs safety work

What might the chart represent?

The slice of the chart

represents

1 in 10 000 actions

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Accidents vs safety work

Successful transfers

Against

Serious errors

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Safety I Accident causation Understand what goes wrong Avoid errors Reduce losses

Safety II Understand what goes right Repeat what goes right Enforce successful behaviours Develop the ability to create

new process on successful behaviours

Gains Comfort Good position Dignity Perceived safety of patient Efficiency Rehabilitation Clinical gains/maintenance

Safety I vs Safety II

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Safety I and Safety II, Erik Hollnagel. (2014)


Safety and Resilience

Oxford English Dictionary Recoil or spring back into shape Withstand or recover quickly from difficult conditions

Organisational Resilience (Vogus and Sutcliffe 2007)

‘positive adjustments under challenging conditions’ ‘vitally prepared for adversity which requires improvement in

overall capacity’

Concept of ‘Brittleness’ (Prof Woods, Ohio State)

Boundaries of performance Graceful extensibility Sustained adaptability

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Outline

Operating Point

Acceptable Performance

Unacceptable workload

Boundary to economic failure

Rasmussen’s Dynamic Risk Model (1997)

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Patient Handling Risks (NBE 2014, Gallagher 2012)

Responses:

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1. Increase infrastructure

2. Increase staff numbers

3. Do nothing


Patient Handling Safety Climate Fray Waterson Munro

(in press)

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Looking wider for possible solutions.

Ergonomics and Human Factors Short courses. Human Factors Concordat (2012) Health Education England (2015) Other providers

MSc Ergonomics (Health and Community Care) Certificate, Diploma, Masters Accreditation for Back Care Management Update modules for all.

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Ergonomics and human factors has some answers but as Johnny Nash once said

‘There are more questions than answers’

[email protected]

Loughborough Design School Is It Raining Out There? An exploration of culture, climate and safety....

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