A "just culture" — an environment where physicians and staff feel confident they can report patient safety incidents without punishment — is critical to improving patient safety. A punitive environment discourages reporting patient safety concerns and limits the organization's ability to prevent patient safety events, inhibiting improvement. Jersey City (N.J.) Medical Center is working toward a just culture through the use of a safety hotline, a phone number physicians and staff can call to anonymously report safety concerns.
The hotline is a resource people can use to report anything from a rip in the floor that may cause someone to trip to a never event, according to Joseph Scott, president and CEO of the hospital. New employees learn about the hotline during orientation, and the value of patient safety is emphasized throughout the organization as one of its founding pillars. "Especially with new employees, we implore them to use the safety hotline if they see something, because they have a fresh perspective on what we're trying to accomplish," Mr. Scott says.
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Hospital leaders check the hotline every day and address the reports. If the issue is simple, like a ripped rug, staff can immediately intervene. For more complex issues, leaders convene process teams to develop solutions.
One issue identified through the hotline that led to an improvement initiative is emergency department throughput. The current ED was built to accommodate approximately 50,000 patients a year, but sees closer to 90,000 patients, according to Mr. Scott. An improvement team developed a process called "code purple" to prevent overcrowding and improve patient flow in the ED.
When the ED gets full, "code purple" is announced on an overhead pager, which is a call for "all hands on deck," Mr. Scott says. Representatives from housekeeping, patient care coordinators and administrators meet in the ED with ED physicians and staff to quickly form a plan of action based on patients' current placement in the hospital. For example, if a physician knows three patients will be discharged soon, the housekeeping staff will be directed to clean the rooms immediately after so that ED patients can move into those rooms. This process creates "a sense of urgency that we're backed up and need to act," Mr. Scott says.
Moving toward a just culture
Creating a just culture is critical to ensuring patient safety and responding to concerns in a timely manner. Mr. Scott says the use of the safety hotline is always reinforced during weekly safety rounds at JCMC as employees and medical staff are encouraged to use the hotline to immediately report any safety concerns. Providing this reporting method encourages transparency and helps foster a healthy environment for both patients and staff.
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