To create a culture of safety, organizations must address those factors known to influence employees' attitudes and behavior. Organizations must also direct measures to reduce hazards in the environment. Although many factors influence a culture of safety, the CDC, in its "Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program," emphasizes the following five strategies that are believed to be the major determinants of a safety culture.
1. Ensure organizational commitment. Organizations can use three important strategies to communicate their involvement in and commitment to safety:
- Include safety-related statements (e.g., zero tolerance for unsafe conditions and practices in the healthcare environment) in statements of the organization's mission, vision, values, goals and objectives;
- Give high priority and visibility to safety committees, teams and work groups (e.g., occupational health, infection control, quality assurance, pharmacy and therapeutics), and ensure direct management involvement in the evaluation of committee processes and impact. Patient safety climate surveys have consistently demonstrated that managers often have a more positive view of the safety climate at their facility than do front-line workers.
- Require action plans for safety in ongoing planning processes. (e.g., an action plan for improving the culture of safety for sharps injury prevention could be one element in an overall safety culture initiative.)
Management can also communicate a commitment to safety indirectly by modeling safe attitudes and practices. Healthcare professionals in positions of leadership send important messages to subordinates when they:
- Handle sharp devices with care during procedures,
- Take steps to protect co-workers from injury, and
- Properly dispose of sharps after use.
Similarly, managers should address sharps hazards in a non-punitive manner as soon as they are observed and discuss safety concerns with their staff on a regular basis. This will positively reflect the organization's commitment to safety and build safety awareness among staff.
2. Involve personnel in the planning and implementation of activities that promote a safe healthcare environment. Involving personnel from various areas and disciplines while planning and implementing activities improves the culture of safety and is essential to the success of such an initiative. Those personnel who participate on committees or teams created to institutionalize safety serve as conduits of information from and to their various work sites. They also legitimize the importance of the initiative in the eyes of their peers.
3. Encourage reporting and elimination of sharps injury hazards. Another strategy for institutionalizing a culture of safety is to create a blame-free environment for reporting sharps injuries and injury hazards. Healthcare personnel who know that management will discuss problems in an open and blame-free manner are more likely to report hazards. Healthcare organizations can also actively look for sharps injury hazards by performing observational rounds and encouraging staff to report near misses and observed hazards in the work place. Once identified, hazards should be investigated as soon as possible to determine the contributing factors, and actions should be taken to remove or prevent the hazard from occurring in the future.
4. Develop feedback systems to increase safety awareness. A number of communication strategies can provide timely information and feedback on the status of sharps injury prevention in the organization. One strategy incorporates findings from hazard investigations, ongoing problems with sharps injuries and prevention improvements into articles in the organization's newsletter, staff memoranda and/or electronic communication tools. It is important to communicate the value of safety by providing feedback when the problem is first observed and commending improvements. Another strategy is to create brochures and posters that enhance safety awareness. Such materials can reinforce prevention messages and highlight management's commitment to safety.
5. Promote individual accountability. Promoting individual accountability for safety communicates a strong message about the organization's commitment to a safe healthcare environment. In order for accountability to be an effective tool, all levels in the organization must comply. An organization can promote individual accountability for safe practices in general-and sharps injury prevention in particular-in many ways. One way is to incorporate an assessment of safety compliance practices in annual performance evaluations; for managers and supervisors, this might include evaluating methods used to communicate safety concerns to their subordinates. Organizations might also consider having staff sign a pledge to promote a safe healthcare environment. This could be incorporated into hiring procedures and/or as part of an organization-wide safety campaign.