Culture of safety

Background

The concept of a healthy patient safety culture in the perioperative setting embraces a number of critical concepts for healthcare practitioners including: recognition of organizational vulnerability in the provision and sustainability of safe patient care; acknowledgment that reporting of patient safety events and near misses relies on a supportive environment; support for staff at all levels to work through identification and analysis of defects, as well as development of system fixes; and organizational support for the infrastructure and resources to address safety events and culture (AHRQ online). These cross many facets of healthcare including perioperative, inpatient, ambulatory, and critical care settings.

When To Err is Human was published in 2000 by the Institute of Medicine (IOM), now the National Academy of Medicine, it was the first time that the number of deaths associated with medical error was actually quantified. Healthcare leaders and researchers were confronted with the glaring dilemma of how 44,000–98,000 deaths per year could happen as a result of apparently preventable adverse events. Improving the culture of safety is no longer optional but a focus of many well-established healthcare organizations in the United States. In 2009, the Joint Commission (JC) published a white paper describing leadership standards addressed by the JC. Leadership Standard LD.03.01.01 states that “leaders create and maintain a culture of safety and quality throughout the hospital.” A particular element of performance addresses that leaders must evaluate the culture of safety and quality using valid and reliable tools.”

Several tools used to assess clician perceptions of safety culture are available in the public domain, including the Safety Attitudes Questionnaire (SAQ) and the Hospital Survey on Patient Safety (HSOPS). ^, In 2010, the National Quality Forum published a paper presenting 34 practices that demonstrate effectiveness in reducing the occurrence of adverse healthcare events. Safe Practice #2 addresses culture measurement, feedback, and intervention ( Fig. 4.1 ).

In 2015, the National Patient Safety Foundation issued a report examining patient safety over the years since the IOM published To Err is Human . This report calls for a systems approach to achieve patient safety and a culture of safety in order to combat this significant area of concern. Recommendations in this report include support for the healthcare workforce and assurance that leaders would establish and sustain a safety culture. We now have established requirements that leaders will measure, evaluate, and sustain a culture of safety, in addition to providing feedback and implementing action plans that are intended to reduce harm and risk. The JC has further identified 11 tenets that reflect the significance of safety culture and how patient harm is prevented (The Joint Commission—see Table 4.1 ).