Creating a culture of safety – a leadership alert

The Joint Commission has found inadequate safety culture to be a significant contributing factor to adverse outcomes. To support this finding, The Joint Commission recently expanded on and re-emphasized the need for the leadership of healthcare organizations to create an effective culture of safety.

Safety culture is the sum of what an organization is and does in the pursuit of safety. Implementing an effective culture of safety requires a multi-layered approach that starts from the top down. Leaders must model appropriate behavior and back up their words with actions. Leadership also must allow staff the freedom to raise safety concerns and report errors without fear of retaliation and recognize these actions as a positive force for quality improvement within the organization. The Joint Commission supports using culture and system assessments regularly to measure progress and to support all efforts with training initiatives.

An effective safety culture save lives. In a 2016 study, Johns Hopkins researchers analyzed medical death rate data over an eight year period. The researchers calculated that more than 250,000 deaths per year are due to medical errors in the U.S. That figure would make medical errors the third leading cause of death in the U.S. behind heart disease and cancer.

The Joint Commission has found that inadequate leadership can contribute to adverse events in various ways, including:

• Insufficient support of patient safety event reporting
• Lack of feedback or response to staff and others who report safety vulnerabilities
• Allowing intimidation of staff who report events
• Refusing to consistently prioritize and implement safety recommendations
• Not addressing staff burnout

Leaders can build safety cultures by readily and willingly participating with care team members in initiatives designed to develop and emulate safety culture characteristics. Open and honest communication between staff and management around quality and safety issues and a willingness to implement quality improvement initiatives to address the issues raised is critical to establish and improve safety outcomes and to reduce adverse events.

How do leaders create an effective culture of safety? The Joint Commission recommends that organizations:

• Implement a transparent, non-punitive approach to reporting and learning from adverse events, close calls and unsafe conditions.
• Establish clear, just, and transparent risk-based processes for recognizing and separating human error and error arising from poorly designed systems or from unsafe or reckless actions that are blameworthy.
• CEOs and all leaders must adopt and model appropriate behaviors and champion efforts to eradicate intimidating behaviors.
• Establish, enforce, and communicate to all team members the policies that support safety culture and the reporting of adverse events, close calls, and unsafe conditions.
• Recognize care team members who report adverse events and close calls, who identify unsafe conditions, or who have good suggestions for safety improvements.
• Establish an organizational baseline measure on safety culture performance.
• Analyze safety culture survey results from across the organization to find opportunities for quality and safety improvement.
• In response to information gained from safety assessments and/or surveys, develop and implement unit-based quality and safety improvement initiatives designed to improve the culture of safety.
• Embed safety culture team training into quality improvement projects and organizational processes to strengthen safety systems.
• Proactively assess system (such as medication management and electronic health records) strengths and vulnerabilities and prioritize them for enhancement or improvement.
• Repeat organizational assessment of safety culture every 18 to 24 months to review progress and sustain improvement.

The Joint Commission introduced patient safety culture concepts in 2008 and has continued to publish guidance and alerts regularly to encourage facilities to take action on this mission-critical initiative. This includes The Patient Safety Systems (PS) chapter of The Joint Commission’s Comprehensive Accreditation Manual for Hospitals which emphasizes the importance of safety culture. As of Jan. 1, 2017, the chapter expanded to critical access hospitals, and to ambulatory care and office-based surgery settings.

The evidence shows that healthcare leaders can impact the culture of safety to reduce adverse events and improve safety outcomes.