Culture of Safety

A culture of patient safety is one in which the organization makes safety a top priority. In an article on the Agency for Healthcare Research and Quality (AHRQ) website, a number of elements that are important to patient safety are described. These factors include prioritizing safety across the organization, leadership support, personal involvement and responsibility, training, ongoing assessment of safety, and clear patient safety goals and policies. Issues with patient safety cannot be addressed unless someone is aware of those problems. In a study by Vital Smarts titled “Silence Kills: The Seven Crucial Conversations for Healthcare” (2005), the authors state, “A majority of healthcare workers regularly see some of their colleagues break rules, make mistakes, fail to offer support, or appear critically incompetent. And yet less than one in ten say anything about it.” The authors go on to say, “…conclude it is critical for hospitals to create cultures of safety, where healthcare workers are able to candidly approach each other about their concerns. However, it would be dangerous to conclude that the responsibility for breaking this pervasive culture of silence depends solely on making it safer to speak up. There are those in every hospital who are already speaking up, and they are not suffering for their outspokenness. In fact, they are the most effective, satisfied, and committed in the organization.”

Hospitals working to improve the safety culture of their organization have a new Web-based resource that provides practical information on the patient safety dimensions used in AHRQ’s Hospital Survey on Patient Safety Culture (HSOPS).  This is organized by dimensions used in the survey, such as teamwork within units, overall perceptions of safety, and feedback and communication about errors.  There are also links to useful tools and a list of general resources from public and private groups involved in patient safety.

Patient safety has been defined in many different ways. The Institute of Medicine (IOM), in its 1999 report, “To Err is Human” defined patient safety as “freedom from accidental injury due to medical care, or to medical errors.” The Agency for Healthcare Research and Quality (AHRQ) defines patient safety as, “freedom from accidental or preventable injuries produced by medical care.” Since the 1999 IOM report, there has been increased emphasis on keeping patients safe and improving the quality of healthcare. The American Nurses Association (ANA), in a position paper titled, “Just Culture” states that they “…support the collaboration of state boards of nursing, professional nursing associations, hospital associations, patient safety centers and individual health care organizations in developing regional and state-wide safety efforts.”

Nurses are vital in closing the gaps in healthcare quality across the United States. In U.S. hospitals, variations in outcomes between hospitals and within the same hospital show that the best science may not be adopted reliably. Maureen Bisognano, in an article in Nurse Executive, stated, “Nurse involvement is essential to any significant healthcare improvement initiative.”

The public is more aware than ever of the risk of injury or harm that might result from medical care because of these efforts. The irony of this is that issues with patient safety are often caused by healthcare providers and organizations that are there to help patients get well and lead happier and healthier lives.