Creating a Culture of Patient Safety

Hospitals are strongly encouraged to foster a culture that emphasizes safe patient care. In intensive care units, where care for patients crosses many disciplines, development of strong multidisciplinary teams is central to improving patient safety. Strengthening ICU teams involves structuring formal and informal communications and team building activities that focus on safety.

Inherent in fostering a culture of safety are particular interaction patterns among ICU teams. Specifically, ICU team members must be comfortable asking each other questions, challenging behaviors of team members and processes of care that have the potential to compromise safety. Additionally, as the demands of a busy work environment change, ICU staff should be comfortable stating their stress level so work can be distributed in ways that maximize the ability of the staff to provide safe patient care. In communicating work-related stress, staff should not fear repercussions but instead should assume that support and a spirit of cooperation and collaboration will follow. The unit should strive for a blend of personal accountability and willingness of staff members to help teammates during crisis situations.

In creating a culture of safety, hospital and ICU leaders and staff should identify and employ a variety of formal and informal mechanisms. Formal mechanisms include continuing education and regular meetings among critical care staff. It also includes communicating the ICU's patient safety culture to the hospital's administrative and operational committees to ensure cooperation from other areas of the hospital. Informal means include networking and social gatherings where safety culture goals can be furthered.

All formal and informal safety improvement activities should approach the issue systematically. Experts in this field argue that “once health professionals are encouraged to view adverse events as errors of the system, it becomes easier for them to identify long-standing procedural routines that might be creating hazards.”1 To improve the hospital’s ability to systematically approach safety improvement, it may be instructive to consider the following eight steps in the process of implementing a culture of safety as adopted by the Johns Hopkins University School of Medicine.

1. Conduct a cultural survey to assess baseline (prevailing) attitudes about medical errors and safety issues
2. Educate staff on the science of safety
3. Identify staff's safety concerns through a safety survey
4. Analyze events
5. Implement improvements
6. Document results
7. Share stories and disseminate results
8. Resurvey staff—cultural survey

1 Making a Science of Patient Safety. John Hopkins University School of Medicine. Pg 5.

© 2004 Michigan Health and Safety Coalition