Culture of Safety

John Morley, MDChief Medical Officer

Jacobi Medical Center & North Central BronxNYC Health & Hospitals

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Friday, March 11, 2011 @ 05:46 UTC

July 6, 2013 @ 11:28 PDT

http://www.ntsb.gov/news/events/Pages/2014_Asiana_BMG-Abstract.aspx

http://www.bbc.com/news/uk-england-stoke-staffordshire-20965469

So…

• What do a University scandal, a Tsunami with a Level 7 nuclear accident, a plane crash and hospital scandal all have in common?

Culture- A set of common, unspoken and assumed

values that drive decision making in an organization or unit.

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What is Culture?

It is NOT -

• A Mission or a Vision statement

• A set of ideals or the wishes of the CEO or executive leadership

• Insignificant

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“Culture”

Professors Ken Thompson (DePaul) and Fred Luthans (Nebraska) identify seven characteristics of culture:

Culture = Behavior

Culture is defined & determined by values But not just any values!

Culture is Learned Through Interaction

Sub-cultures Form Through Rewards

People Shape the Culture

Culture is Negotiated (priorities are negotiated)

Culture is Difficult to Change

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What is Culture?• It is Actions!! It is behaviors!!

• I have always thought the actions of men the best interpreters of their thoughts. — John Locke

• Well done is better than well said. — Benjamin Franklin

• Remember, people will judge you by your actions, not your intentions. You may have a heart of gold — but so does a hard-boiled egg. — Author Unknown

• Ironically, making a statement with words is the least effective method. — Grey Livingston

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What is Culture?

• We are all inclined to judge ourselves by our ideals; others, by their acts. — Harold Nicolson

• When deeds speak, words are nothing. — African Proverb

• I grow older I pay less attention to what men say. I just watch what they do. — Andrew Carnegie

• People may doubt what you say, but they will believe what you do. — Lewis Cass

http://media.pennlive.com/midstate_impact/other/REPORT_FINAL_071212.pdf

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http://usatoday30.usatoday.com/news/nation/story/2012-07-12/louis-freeh-report-penn-state-jerry-sandusky/56181956/1

http://i.usatoday.net/news/nation/2012-07-12-penn-state-freeh-report.pdf

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http://www.nirs.org/fukushima/naiic_report.pdf

20http://www.reuters.com/article/2014/02/10/us-asiana-culture-idUSBREA1906U20140210

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/226703/Berwick_Report.pdf

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http://www.youtube.com/watch?v=5CcLIPaUz3E

http://www.youtube.com/watch?v=AbFIPc34AJ8

A winning culture at Zappos

https://www.youtube.com/watch?v=cQLTQAv5JQA

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“Safety Culture”• First used in INSAG’s (1988) ‘Summary Report on

the Post-Accident Review Meeting on the Chernobyl Accident’ where safety culture was described as: “That assembly of characteristics and attitudes in organizations and individuals which establishes that, as an overriding priority, nuclear plant safety issues receive the attention warranted by their significance.”

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http://pbadupws.nrc.gov/docs/ML1208/ML120810464.pdf

So what do we know about our culture?

30http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/resources/hospscanform.pdf

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Areas of Strength for Most HospitalsThe four areas with the highest % positive responses:1. Teamwork Within Units (average 80% positive

response)2. Supervisor/Manager Expectations and Actions

Promoting Pt. Safety (average 75% positive response)3. Organizational Learning—Continuous Improvement

(average 72% positive response)4. Management Support for Patient Safety (average 72%

positive response)

http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/2012/hosp12summ.html

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Areas With Potential for Improvement for Most Hospitals

Three areas showed potential for improvement:

1. Non-punitive Response to Error (average 44% positive response)

2. Handoffs and Transitions (average 45% positive response)

3. Staffing (average 56% positive response)

What is it that defines YOUR culture?

Loyal

Honesty

Dependable

Committed

Open minded

Committed

Transparency

Quality

Safety

Creative

Innovative

Respect

$Revenue$

Courageous

Efficient

Effective

Patient/Family Centered

Effective

Equitable

Timely

Values

Consistent/ HRO

Compassion

Speaking up

• Dependable• Revenue• Loyal• Quality• Committed• Open-minded• Consistent• Honest• Efficient• Innovative• Creative• Humorous• Fun-loving• Motivated• Honesty• Transparency

• Positive• Honesty• Optimistic• Inspiring• Passionate• Respectful• Athletic• Fit• Courageous• Educated• Respected• Loving • Nurturing• Adventurous

Mt. Saint Everywhere General

Safe, Effective, Efficient, Timely, Family Centered and Equitable

1. Revenue2. Dependable3. Loyal4. Committed5. Open-minded6. Consistent7. Honest8. Efficient9. Innovative10. Creative11. Humorous12. Fun-loving13. Motivated14. Honest15. Positive

16. Optimistic17. Inspiring18. Passionate19. Respectful20. Athletic21. Healthy employees22. Courageous23. Educated24. Respected25. Loving 26. Nurturing27. Adventurous28. Transparency29. Quality 30. Safety

1. Football2. Revenue3. Football4. Committed5. Open-minded6. Academics7. Football8. Efficient9. Innovative10. Football11. Honest12. Fun-loving13. Motivated14. Football15. Positive

16. Optimistic17. Inspiring18. Passionate about football19. Respectful20. Athletic21. Healthy employees22. Courageous23. Educated24. Respected25. Loving 26. Nurturing27. Adventurous28. Transparency29. Quality 30. Safety

Penn State

Protection of children

1. Safety2. Quality3. Transparency4. Speaking up5. Dependable6. Reliable7. Loyal8. Committed9. Open-minded10. Consistent11. Honest12. Efficient13. Innovative14. Creative15. Humorous

16. Fun-loving17. Motivated18. Honest19. Positive20. Optimistic21. Inspiring22. Passionate23. Respectful24. Healthy employees25. Courageous26. Educated27. Respected28. Loving 29. Nurturing30. Adventurous

Your hospital

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http://www.nejm.org/doi/pdf/10.1056/NEJMp0801863

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http://onlinelibrary.wiley.com/doi/10.1002/jhm.2092/abstract

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High Reliability Organizations

This mindset is supported by five characteristic ways of thinking: • preoccupation with failure• reluctance to simplify explanations for

operations, successes, and failures• sensitivity to operations (situation awareness)• deference to frontline expertise• commitment to resilience

https://psnet.ahrq.gov/primers/primer/31

1. Safety2. Quality3. Transparency4. Dependable5. Reliable6. Loyal7. Committed8. Open-minded9. Consistent10. Honest11. Efficient12. Innovative13. Creative14. Humorous15. Fun-loving

16. Motivated17. Honest18. Positive19. Optimistic20. Inspiring21. Passionate22. Respectful23. Athletic24. Healthy employees25. Courageous26. Educated27. Respected28. Loving 29. Nurturing30. Adventurous

Your hospital

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In the beginning was the Plan. . .

• In the beginning was the Plan.And then came the Assumptions.And the Assumptions were without form.And the Plan was without substance.And darkness was upon the face of the Workers.

• And the Workers spoke among themselves, saying, "This is a crock…and it stinks."

• And the Workers went unto their Supervisors and said, "It is a pail of dung, and we can't live with the smell."

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In the beginning was the Plan. . .

• And the Supervisors went unto their Managers, saying, "It is a container of excrement, and it is very strong, such that none may abide by it.“

• And the Managers went unto their Directors, saying, "It is a vessel of fertilizer, and none may abide its strength."

• And the Directors spoke among themselves, saying to one another, "It contains that which aids plant growth, and it is very strong."

• And the Directors went to the Vice Presidents, saying unto them, "It promotes growth, and it is very powerful."

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In the beginning was the Plan. . .

• And the Vice Presidents went to the President, saying unto him, "This new plan will actively promote the growth and vigor of the company with very powerful effects."

• And the President looked upon the Plan and saw that it was good.

• And the Plan became Policy.• And that, my friends, is how …it Happens.

Culture of Safety

• Even if you are not defining the institutional culture, you are part of a unit and a shift and you are a part of defining that culture.

• The only way to know your culture is to be a part of it. Get out there and lead.

• Be a part of making your culture a Culture of Safety or even better a HRO

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If I have seen further it is by standing on ye shoulders of Giants.

— Sir Isaac Newton