Most, if not all, hospitals and health systems have some version of a safety program in place that emphasizes patient, workplace and environmental safety, says Lillee Gelinas, MSN, RN, FAAN, vice president and chief nursing officer at VHA Inc., a nationwide network of more than 1,400 not-for-profit hospitals that work together to improve their clinical and economic performance. Ms. Gelinas says the difficulty in creating a safety program is not in the educational aspect. "In the healthcare industry, we don't lack evidence, ideas or the white papers necessary to produce safety education. What I have seen the industry lack is execution skill," Ms. Gelinas says.
Here are eight principles that can guide healthcare providers in successfully executing a culture of safety through sound educational programs at their respective organizations.
Levels of impact
Ms. Gelinas says a successful healthcare safety program must be able to transcend three impact levels, each necessitating different educational and assessment approaches.
Personal-level impact. Hospitals must launch a safety approach with programs that ensure each employee learns and adopts the necessary personal skills and competencies to promote patient safety. Each employee should possess several key personal skills, including courage, engagement and a strong understanding of one's own beliefs and values. For instance, an employee who sees a surgeon who has not washed his or her hands should have the courage to stop that surgeon from starting a procedure.
"If a true culture of safety is in place, there's already an expectation that an employee will feel safe and confident in calling out their colleagues' shortcomings," Ms. Gelinas says.
There are a variety of ways to assess each employee's personal perception and impact on patient safety. One strategy employed by VHA hospital leaders includes a time assessment. How many minutes a day are employees unnecessarily spending on their cell phones, as opposed to documenting? Or engaging in direct patient care? It takes time to be safe, to listen and talk to patients about their healthcare and to comfort them. This time assessment helps individual practitioners see firsthand how their multitasking may or may not be in line with the healthcare organization's mission for patient safety, Ms. Gelinas explains.
Unit-level impact. Ms. Gelinas says the individual-level of a patient safety culture should naturally progress into department- or unit-level safety. The Agency for Healthcare Research and Quality administers a survey that allows hospitals and health systems to assess how the culture of patient safety is played out in individual units, such as pediatrics or obstetrics. The survey covers very specific aspects of patient safety culture, which can be particularly useful. For instance, staff members of a particular hospital unit may report a great teamwork environment but also some breakdowns in communication, which can prove detrimental to safety.
To view AHRQ's survey on patient safety culture and distribute it within your own healthcare organization, click here.
Organization-level impact. Leaders must ensure programs that support a safety culture have an organization-level impact. This hinges on administrators' ability to create cohesive and comprehensive missions related to safety. Ms. Gelinas says achieving enterprise-wide safety is not possible without engaging the frontline staff in safety. .
"Once we've assessed the personal, departmental, and organizational expectations related to safety, hospital leaders can begin to craft programs and strategies that close all the knowledge gaps," she says.
Cultural pillars
Although safety approaches must be delivered on all three impact levels, programs must also take into account a wide variety of cultural factors that can make or break the success of an organization's safety goals.
Openness. Every healthcare organization, no matter the size, should have an open-door policy in place, Ms. Gelinas says. Such a policy helps foster a culture of openness and encourages employees to believe there is no such thing as a "non-discussable" issue. This applies to employees and patients. A VHA hospital in North Carolina ensures that a patient advocate is present at all meetings so patient and families' interests are always taken into account.
"Everyone must be able to discuss anything, at anytime, related to any issue, and know they are working in a safe environment, where they won't be ridiculed or pigeon-holed," she says.
Respect. Although the importance of collegial respect may be common sense, it cannot be reiterated enough. Ms. Gelinas urges every healthcare organization to establish a zero-tolerance policy for bullying in any shape or form, electronically or verbally. That collegial respect must be extended to patients and families.
With the rapid boom of social networking, she adds, healthcare organizations may find it helpful to institute a social media policy to prevent the risk of harm to employees and patients through this medium. The American Nurses Association offers nurses social media guidelines comprised of tips and principles that promote awareness of the potential harm from online behavior.
To access the ANA's tips and principles for nurses and social media, click here.
Program creation
Once the cultural and impact factors have been accounted for, healthcare organizations can begin working to create a sound infrastructure to assure a "safe" organization.
Timeliness. Safety programs must be updated on a regular basis to keep up with changes published in medical literature and industry standards. Ms. Gelinas says most safety programs don't have to undergo major changes frequently — 80 percent of most programs have a long shelf-life — but there is still the 20 percent that must be updated and reworked to stay ahead of the curve.
Adaptability. Considering the diverse range of roles and learning styles of each employee, hospitals must ensure that their safety programs are crafted and altered to cater to each audience, whether it is the environmental services department or executive administration. Diligently crafting safety programs this way will ensure each employee fully grasps the safety education appropriate for his or her role.
"You can't just design a one-hour program for everyone," Ms. Gelinas says. "The program may have to be administered through a number of venues, such as face-to-face meetings, in a large classroom or via webinars and conference calls. In this day and age, you need multiple ways to reach out and engage people in the learning process. One size does not fit all."
Assessments. Regular assessments of healthcare employees' skills and knowledge will be critical, as it will allow an individual to evaluate his or her own competency. One example is a 360 safety assessment, completed by peers, subordinates and supervisors. This approach evaluates the staff members' strengths and weakness in the context of maintaining safety and helps evaluate the safety program's effectiveness, Ms. Gelinas says.
"A hospital can have all the topics and tactics in the world, but alone, they won't spur change," she says. The most successful safety programs use the 2-by-3 approach:
1. Programs are consistently executed
2. Programs engage people through:
Here are eight principles that can guide healthcare providers in successfully executing a culture of safety through sound educational programs at their respective organizations.
Levels of impact
Ms. Gelinas says a successful healthcare safety program must be able to transcend three impact levels, each necessitating different educational and assessment approaches.
Personal-level impact. Hospitals must launch a safety approach with programs that ensure each employee learns and adopts the necessary personal skills and competencies to promote patient safety. Each employee should possess several key personal skills, including courage, engagement and a strong understanding of one's own beliefs and values. For instance, an employee who sees a surgeon who has not washed his or her hands should have the courage to stop that surgeon from starting a procedure.
"If a true culture of safety is in place, there's already an expectation that an employee will feel safe and confident in calling out their colleagues' shortcomings," Ms. Gelinas says.
There are a variety of ways to assess each employee's personal perception and impact on patient safety. One strategy employed by VHA hospital leaders includes a time assessment. How many minutes a day are employees unnecessarily spending on their cell phones, as opposed to documenting? Or engaging in direct patient care? It takes time to be safe, to listen and talk to patients about their healthcare and to comfort them. This time assessment helps individual practitioners see firsthand how their multitasking may or may not be in line with the healthcare organization's mission for patient safety, Ms. Gelinas explains.
Unit-level impact. Ms. Gelinas says the individual-level of a patient safety culture should naturally progress into department- or unit-level safety. The Agency for Healthcare Research and Quality administers a survey that allows hospitals and health systems to assess how the culture of patient safety is played out in individual units, such as pediatrics or obstetrics. The survey covers very specific aspects of patient safety culture, which can be particularly useful. For instance, staff members of a particular hospital unit may report a great teamwork environment but also some breakdowns in communication, which can prove detrimental to safety.
To view AHRQ's survey on patient safety culture and distribute it within your own healthcare organization, click here.
Organization-level impact. Leaders must ensure programs that support a safety culture have an organization-level impact. This hinges on administrators' ability to create cohesive and comprehensive missions related to safety. Ms. Gelinas says achieving enterprise-wide safety is not possible without engaging the frontline staff in safety. .
"Once we've assessed the personal, departmental, and organizational expectations related to safety, hospital leaders can begin to craft programs and strategies that close all the knowledge gaps," she says.
Cultural pillars
Although safety approaches must be delivered on all three impact levels, programs must also take into account a wide variety of cultural factors that can make or break the success of an organization's safety goals.
Openness. Every healthcare organization, no matter the size, should have an open-door policy in place, Ms. Gelinas says. Such a policy helps foster a culture of openness and encourages employees to believe there is no such thing as a "non-discussable" issue. This applies to employees and patients. A VHA hospital in North Carolina ensures that a patient advocate is present at all meetings so patient and families' interests are always taken into account.
"Everyone must be able to discuss anything, at anytime, related to any issue, and know they are working in a safe environment, where they won't be ridiculed or pigeon-holed," she says.
Respect. Although the importance of collegial respect may be common sense, it cannot be reiterated enough. Ms. Gelinas urges every healthcare organization to establish a zero-tolerance policy for bullying in any shape or form, electronically or verbally. That collegial respect must be extended to patients and families.
With the rapid boom of social networking, she adds, healthcare organizations may find it helpful to institute a social media policy to prevent the risk of harm to employees and patients through this medium. The American Nurses Association offers nurses social media guidelines comprised of tips and principles that promote awareness of the potential harm from online behavior.
To access the ANA's tips and principles for nurses and social media, click here.
Program creation
Once the cultural and impact factors have been accounted for, healthcare organizations can begin working to create a sound infrastructure to assure a "safe" organization.
Timeliness. Safety programs must be updated on a regular basis to keep up with changes published in medical literature and industry standards. Ms. Gelinas says most safety programs don't have to undergo major changes frequently — 80 percent of most programs have a long shelf-life — but there is still the 20 percent that must be updated and reworked to stay ahead of the curve.
Adaptability. Considering the diverse range of roles and learning styles of each employee, hospitals must ensure that their safety programs are crafted and altered to cater to each audience, whether it is the environmental services department or executive administration. Diligently crafting safety programs this way will ensure each employee fully grasps the safety education appropriate for his or her role.
"You can't just design a one-hour program for everyone," Ms. Gelinas says. "The program may have to be administered through a number of venues, such as face-to-face meetings, in a large classroom or via webinars and conference calls. In this day and age, you need multiple ways to reach out and engage people in the learning process. One size does not fit all."
Assessments. Regular assessments of healthcare employees' skills and knowledge will be critical, as it will allow an individual to evaluate his or her own competency. One example is a 360 safety assessment, completed by peers, subordinates and supervisors. This approach evaluates the staff members' strengths and weakness in the context of maintaining safety and helps evaluate the safety program's effectiveness, Ms. Gelinas says.
"A hospital can have all the topics and tactics in the world, but alone, they won't spur change," she says. The most successful safety programs use the 2-by-3 approach:
1. Programs are consistently executed
2. Programs engage people through:
- Their hands (their practices)
- Their hearts (their passion)
- Their minds (their knowledge)
