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
July 6, 2013 @ 11:28 PDT
http://www.ntsb.gov/news/events/Pages/2014_Asiana_BMG-Abstract.aspx
http://www.bbc.com/news/uk-england-stoke-staffordshire-20965469
So…
• What do a University scandal, a Tsunami with a Level 7 nuclear accident, a plane crash and hospital scandal all have in common?
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
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
20http://www.reuters.com/article/2014/02/10/us-asiana-culture-idUSBREA1906U20140210
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
So what do we know about our culture?
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)
What is it that defines YOUR culture?
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
• 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
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
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
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
https://psnet.ahrq.gov/primers/primer/31
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.
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
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