Since the book, To Err is Human: Building a Safer Healthcare System (Committee on Quality Health Care in America, Institute of Medicine) broke the silence in 2000 that had surrounded medical errors and their consequence, a culture of safety has evolved in healthcare organizations with an ever growing body of knowledge and useful tools for healthcare professionals.
"It all comes down to the culture of the organization," says Richard Croteau, MD, executive director for patient safety initiatives for the Joint Commission International Center for Patient Safety. "We recognize that different organizations have different cultures, and it's heavily dependent on the leadership and the message that's sent and how patient safety is seen in the context of all of the operations. What we're looking for are organizations in which safety is the primary consideration in everything that's done; it's not seen as someone's job to ‘do' patient safety, but rather that's what the organization focuses on in everything it does."
Culture is the how and why you do what you do. Within an ASC each discipline can have a different culture (e.g. at surgeons vs. anesthesia vs. OR nurses vs. Preop/PACU Nurses vs. front office). Each work unit (Preop, PACU, OR, Front Office) with in an ASC can also have a different culture. These differences can help or impede the work. Differences in culture result frequently in perceptual and communication difficulties. The safety culture crosses disciplines and work units in the ASC with paths of clear communication and a team approach to achieve the facility's safety goals. The intent is to look at process and/or system failures, and, to solve them in a non-biased, non-threatening way.
Therefore, the safety, risk management and quality initiatives we have enforced at our respective ASCs have evolved over the last 13 years and have created paths of clear communication and a team approach to achieve the shared goal of safe, high quality care across the professional disciplines and the work units. When something goes wrong, the attention is on what happened and why, not specific individuals.
Sidney Decker in his 2007 book "Just Culture: Balancing Safety with Accountability" lays out how building a "just culture" is critical for the creation of a safety culture. Without reporting of failures and problems, without openness and information sharing, a safety culture cannot flourish. Errors can be expected at three levels according to Decker:
1) Human error - an unintended mistake,
2) Risky behavior - a choice was made that increased risk or it was thought such risk was acceptable, and
3) Reckless behavior – a conscious choice to disregard risk
In looking at serious patient safety events within the scope of these criteria, we can quickly redesign our safety systems in place as failures and problems occur.
One tool to do a safety culture check-up in an ASC is available from the Agency for Healthcare, Research and Quality (AHRQ) Hospital Survey. While specifically designed for hospital use, many of the questions are applicable to any healthcare setting like the ASC. (www.ahrq.gov). The survey can be used to:
i. Raise staff awareness about patient safety.
ii. Diagnose and assess the current status of patient safety culture.
iii. Identify strengths and areas for patient safety culture improvement.
iv. Examine trends in patient safety culture change over time.
v. Evaluate the cultural impact of patient safety initiatives and interventions.
vi. Conduct internal and external comparisons.
The Patient Safety Group, a separate entity, offers, for a fee, to assist healthcare organizations to administer and analyze the AHRQ survey. (https://www.patientsafetygroup.org/survey/home.cfm)
"It all comes down to the culture of the organization," says Richard Croteau, MD, executive director for patient safety initiatives for the Joint Commission International Center for Patient Safety. "We recognize that different organizations have different cultures, and it's heavily dependent on the leadership and the message that's sent and how patient safety is seen in the context of all of the operations. What we're looking for are organizations in which safety is the primary consideration in everything that's done; it's not seen as someone's job to ‘do' patient safety, but rather that's what the organization focuses on in everything it does."
Culture is the how and why you do what you do. Within an ASC each discipline can have a different culture (e.g. at surgeons vs. anesthesia vs. OR nurses vs. Preop/PACU Nurses vs. front office). Each work unit (Preop, PACU, OR, Front Office) with in an ASC can also have a different culture. These differences can help or impede the work. Differences in culture result frequently in perceptual and communication difficulties. The safety culture crosses disciplines and work units in the ASC with paths of clear communication and a team approach to achieve the facility's safety goals. The intent is to look at process and/or system failures, and, to solve them in a non-biased, non-threatening way.
Therefore, the safety, risk management and quality initiatives we have enforced at our respective ASCs have evolved over the last 13 years and have created paths of clear communication and a team approach to achieve the shared goal of safe, high quality care across the professional disciplines and the work units. When something goes wrong, the attention is on what happened and why, not specific individuals.
Sidney Decker in his 2007 book "Just Culture: Balancing Safety with Accountability" lays out how building a "just culture" is critical for the creation of a safety culture. Without reporting of failures and problems, without openness and information sharing, a safety culture cannot flourish. Errors can be expected at three levels according to Decker:
1) Human error - an unintended mistake,
2) Risky behavior - a choice was made that increased risk or it was thought such risk was acceptable, and
3) Reckless behavior – a conscious choice to disregard risk
In looking at serious patient safety events within the scope of these criteria, we can quickly redesign our safety systems in place as failures and problems occur.
One tool to do a safety culture check-up in an ASC is available from the Agency for Healthcare, Research and Quality (AHRQ) Hospital Survey. While specifically designed for hospital use, many of the questions are applicable to any healthcare setting like the ASC. (www.ahrq.gov). The survey can be used to:
i. Raise staff awareness about patient safety.
ii. Diagnose and assess the current status of patient safety culture.
iii. Identify strengths and areas for patient safety culture improvement.
iv. Examine trends in patient safety culture change over time.
v. Evaluate the cultural impact of patient safety initiatives and interventions.
vi. Conduct internal and external comparisons.
The Patient Safety Group, a separate entity, offers, for a fee, to assist healthcare organizations to administer and analyze the AHRQ survey. (https://www.patientsafetygroup.org/survey/home.cfm)