3 Questions to Ask in Order to Create a Culture of Clinical Accountability

At the 19th Annual Ambulatory Surgery Centers Conference in Chicago on Oct. 25, Kelly Bemis, group director of clinical services for Surgical Care Affiliates, discussed three questions surgery centers must take in order to develop and maintain a culture of accountability, which is critical to preserve patient safety.

"When we talk about clinical accountability, we have to remember it's about the people," she said. "[Healthcare providers] have the ability to change the lives of patients for the better, but we also have the potential for harming patients. When it comes to healthcare harm, good is not enough."

1. What does a robust culture of accountability look like?
•    Teammates speak up
•    No shortcuts; follow policies and procedures established to maintain patient safety
•    Teamwork
•    Continuous and proactive improvement
•    Measurement and transparency

2. What are the barriers to a culture of accountability?
•    Failure to speak up about mistakes
•    Failure to speak up about broken rules
•    Failure to speak up about shortcutting
•    Failure to speak up about incompetence

Reasons why nurses or other practitioners fail to speak up include lack of ability, time, feat of retaliation, low confidence and the belief that it is "not my job." The results lead to unavoidable errors, high turnover, decreased morale and reduce productivity.

3. So what steps can providers take to improve the culture of accountability?
•    Conduct a patient safety culture survey
•    Conduct focused communications about results of that survey
•    Lead, encourage and measure a culture of accountability

Ultimately, centers must measure their success by the rate of wrong site surgery, falls, burns, medication errors and other types of adverse events — down to zero.

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