Safety Leadership: Safety Leadership: Lessons from healthcare and - - PDF document
Safety Leadership: Safety Leadership: Lessons from healthcare and other industries Rhona Flin Industrial Psychology Research Centre Scottish Patient Safety Research Network Scottish Patient Safety Research Network HPME, University of Toronto,
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Rhona Flin Industrial Psychology Research Centre Scottish Patient Safety Research Network Scottish Patient Safety Research Network
HPME, University of Toronto, 20 October, 2009
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Welcome to the Industrial Psychology Research Centre. The centre specialises in the application
The group has worked with the oil industry since 1986, and regularly engage in consultancy
generation, surgery, emergency services, conventional power generation and transportation. Interests of the centre include:
Crew Resource Management
Clients include: Agip, AKER Offshore (Norway), AMEC, Amerada Hess, AMOCO, British Energy, BHP, BP, Brown & Root, Chevron, Civil Aviation Authority, Coflexip Stena Offshore, Conoco Phillips, Defence Evaluation and Research Agency (DERA), EC (DGTREN), First Group, Halliburton, Health & Safety Executive, KBR, Kerr McGee, National Power, NHS, Powergen, Royal College of Surgeons, Salamis SGB, Schlumberger, SCPMDE, Shell, Talisman, Texaco, Total Fina Elf, Transocean Sedco Forex, UBS Warburg & UK Nuclear Imc.
Technical Accident Causation Technical Factors (30-20%) Human Factors
Managers + Organisation Culture Worker Behaviour
(+/- 80%?) (+/- 20%?) (70-80%)
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h t i ti f l d ? – characteristics of leader?
– what do good leaders do?
– under given conditions, what behaviour is likely to be effective? Adaptability. be effective? Adaptability.
– Interaction between leader and follower. Charisma, vision, inspiration. Authenticity.
45% of organizational performance can be explained
45% of organizational performance can be explained b i l d hi (D & L d 1988) b i l d hi (D & L d 1988) by executive leadership (Day & Lord, 1988) by executive leadership (Day & Lord, 1988)
supervisor is the most stressful aspect of their job (e.g. Fiedler)
turnover, stress, litigation, apathy, quality of work life, job satisfaction, motivation, organisational commitment, attention, rule compliance, …safety
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“Top management shall take p g ultimate responsibility” …for safety and safety management systems
(OHSAS 18001:2007;Section 4.4.1)
“BP has not adequately established process safety as a core value…BP d f h d d executive and corporate refining management have not provided effective safety leadership.”
(Baker, 2007, p. 60)
“BP has not provided effective leadership on or established appropriate
U.S. refineries [and] the panel believes that the lack of effective leadership is systemic, touching all levels of BP’s corporate management having responsibility for BP’s U.S. refineries (Baker, 2007 p.66). p.66). U.S. Chemical Safety and Hazard Investigation Board (CSB, 2005, p3) urged: “corporate officials (to) exercise appropriate leadership to promote adherence to safety management systems”
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Senior management commitment
between all levels of l [ t employee [management action]
and production goals [management prioritisation]
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(Kessler et al, 2001)
(Vaughan, 1996, p398)
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(Vaughan, 1996, p398)
(Woods, 2003)
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(Gehman, 2003)
Through Red at Amsterdam Central (2005)
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– detection and recognition of threats
– balancing competing pressures – ability to make ‘sacrificial decisions’ (Woods)
– speaking up – challenging the leader
November 1999
public inquiry that managers ignored him because they thought they might lose government cash.
senior staff wanted to maintain the hospital's designation as a specialist children's heart facility.
a train where occasional passengers were falling off, and the train had to keep moving in order to attract funding.
patient safety by reasons of funding and continued activity in high risk areas."
Roylance, later struck off by the General Medical Council, was "dismissive" of his attempts to bring the high death rates to his attention, he said.
from practising, was angry that he had discussed the unit's performance with other doctors.
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(Workforce Survey (Mearns, Flin et al 1998) - Aggregate data from 13 companies)
safety leadership style
consistent messages about safety commitment
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Transformational leadership (Bass) is the strongest predictor
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Sample: Oil industry Senior Managers & Health and Safety Experts (n=14) Interview: Semi-structured format; Open questions to elicit detailed opinions, anecdotes & descriptions Data Analysis: Transcription; Identification and coding of recurring themes Aim: Summarise expert opinion regarding characteristics of effective and ineffective safety leadership for the oil and gas industry at the senior level. Match to components of transformational and authentic leadership.
“doing safety well comprises a number
fundamental belief, the ability to
, y communicate that belief, and to get
–Senior Manager
–HSE Manager
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Characteristics: Genuine, Consistent, Trustworthy, y Hopeful, Approachable, Communicative, Fair (Avolio et al)
“speak in an authentic way, it’s very easy to know the words around (safety), but the people who really mean it and are authentic…it comes across in a much more powerful way”
g
“the way people judge you and the way they accept the words that you issue…I think a lot of it is about just being genuine”
Upon delivering safety messages… “really (need to be) seen by the
Senior Manager “it’s important that what people say, is actually what happens. The network quickly understands if there’s a dissonance” Senior Manager “the most important thing is that managers have to not only talk the right language and set the right policies, they actually have to show by their actions that they are committed to safety” HSE Manager
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“encourage the flow of all information”
HSE M
“a willingness to hear bad news…they need to have a kind of openness”
“it’s my experience that it’s far better to have an honest discussion about
to have an honest discussion about the realities, to explain what is and isn’t possible, and to discuss what we can do together”
Senior Manager
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Effective safety leaders display qualities that are beyond the scope of the transformational leadership model. p The characteristics of effective safety leaders align closely with characteristics associated with authentic leadership models.
These preliminary data suggest that authentic leadership is a central aspect of effective safety leadership at the senior management level.
‘clubby’ atmosphere which prevented speaking up (Bristol - Kennedy, 2001)
failed to follow infection advice or learn lessons from the first
managers who can be responsible if they are aware of problems but fail to act but fail to act
involve leadership failings
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“Safety still struggling to be on the agenda. Strong leadership needed.”
(Flin & Yule from McKee et al NHS culture study, 2008, SDO) 8 NHS Trust CEOs from across England and their exec boards, randomly selected on performance ratings
safety climate
– Online survey. Completed by CEO (self-perception) and Executive board (upward ratings). Survey covered Transformational/ transactional leadership style, safety climate, leadership behaviours, d i ff/ i f and action on staff/ patient safety
– 1 hour interview recorded and transcribed verbatim. Coding for leadership style, safety behaviours (NPSA) and values
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Transformational Leadership
CHARISMA INSPIRATION INDIVIDUALIZED CONSIDERATION INTELLECTUAL STIMULATION
+ +
Transactional Leadership
HEIGHTENED MOTIVATION TO ATTAIN DESIGNATED OUTCOMES (EXTRA EFFORT) EXPECTED EFFORT
Transactional Leadership
MANAGEMENT- BY-EXCEPTION CONTINGENT REWARD
+
PERFORMANCE BEYOND EXPECTATIONS EXPECTED PERFORMANCE Bass & Avolio (1994) Transformational Leadership
Flin & Yule (2004). Qual Saf Health Care, 13 (supplII) ii45-ii51
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1 Build a safety culture
y
National Patient Safety Agency (2004)
Flin, Yule et al, The Surgeon 2006
Scotland – rated by surgeons
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T f ti l (I t ll t l “I lik t f ilit t I lik l t t Coded leadership style/ value Interview data Transformational (Intellectual Stimulation) “I like to facilitate, I like people to come to their own conclusions rather than say ‘right, this is my idea’…” Transactional (Contingent reward) “I tend to want to set clear goals and I expect people to achieve them” Transactional (Management by exception) “…need to be able to move into a command and control mode to ensure things are delivered.” Organizational value “Our culture is based on a principle that we need to learn from incidents” Personal value “We’ll continue to strive to hit it (the Healthcare Commission target) but I won’t compromise patient care as a consequence”
NPSA guidance category CEO leadership behaviour from the interview analysis (n=7)
1 B ild f l S i h CEO’ l bj i h i
Setting out the CEO’s clear objectives on the intranet and newsletters
Providing clarity and unambiguous messages to staff regarding the future of the Trust
management Including systems failures and cost of drug errors in long-term financial strategy
Demonstrate to staff that action happens and things change as a result of safety reports change as a result of safety reports
public Speaking to patients on the ward and asking them what it is like in the hospital
Sending senior staff on patient safety training courses
Providing resources to support the handwashing policy and removing barriers to implementation
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g y p y using climate surveys and upward appraisal techniques (in which staff review or appraise their managers and leaders).(14,25)
performance review, make sure they ask about the safety issues the manager encountered, how they were handled, and the impact their actions had on reducing unsafe conditions conditions.
Reward and recognize those whose efforts contribute to safety.
h l h i i l d hi i id d b h
governing body, the chief executive and senior managers, and the leaders of the clinical staff. When a sentinel event occurs in a health care organization, inadequate or ineffective leadership is often one of the contributing factors. In fact, inadequate leadership was a contributing factor in 50 percent of the sentinel events reported to The Joint Commission in 2006. Research shows that leadership makes a major difference in the quality and safety of patient care.
t d hi h l d t th t ” J ff S lb CEO systems and processes which led to the event,” says Jeff Selberg, CEO
systems and processes which provide the framework for the clinical environment our staff works within. My first priority is to understand how we improve our clinical environment to reduce the possibility of doing harm.”
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Sarah Parker (PhD student 2008-11) & Yule, Flin, McKinley i i l d hi Surgeons’ intra-operative leadership Reader, Flin & Cuthbertson Consultants’ ‘floor’ leadership in the ICU (Manuscript under review).
C t i El t Categories Elements Situation Awareness
Gathering information Understanding information Projecting and anticipating future state
Decision Making
Considering options Selecting and communicating option Implementing and reviewing decisions
Communication
Exchanging information
Communication and Teamwork
Exchanging information Establishing a shared understanding Co-ordinating team activities
Leadership
Setting and maintaining standards Coping with pressure Supporting others
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“The NHS lags unacceptably behind
as aviation, in recognising the importance of effective team working and other non-technical skills.” (p5) “There are serious deficiencies in the undergraduate medical curriculum .. which are detrimental to patient safety which are detrimental to patient safety, in respect of training in:
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