THE ROLE OF LEADERS IN DEVELOPING A CULTURE OF SAFETY Dr. Nicola - - PowerPoint PPT Presentation

• Dr. Nicola Ryley

Chief Nursing Officer, Hamad Medical Corporation

Frank Federico, RPh

Vice President, Senior Safety Expert Institute for Healthcare Improvement

THE ROLE OF LEADERS IN DEVELOPING A CULTURE OF SAFETY

Middle East Forum

March 2019

ME Forum 2019 Orientation

As part of our extensive program and with CPD hours awarded based on actual time spent learning, credit hours are offered based on attendance per session, requiring delegates to attend a minimum of 80% of a session to qualify for the allocated CPD hours.

• Less than 80% attendance per session = 0 CPD hours
• 80% or higher attendance per session = full allotted CPD hours

Total CPD hours for the forum are awarded based on the sum of CPD hours earned from all individual sessions.

Disclosure

• The presenters have no conflict of interest to

disclose

Description

• A culture of safety is defined as a culture in which the safety of a patient

comes before all else, individuals are not afraid to speak, and learning comes from good and bad events. Leaders at all levels of an organization play a significant role in fostering this culture. In this session, we will discuss the behaviors and actions that help foster and maintain this culture.

Objectives

• Define a culture of safety for your organization
• Describe the behaviors and attitudes necessary to foster

that culture

• List three actions that you will take when you return to

your organization to determine your present culture and foster a culture of safety.

What is a Culture of Safety?

Reflection: what does a culture of safety mean to you?

Agency for Healthcare Research and Quality

Defines “safety culture” as: The safety culture of an organization is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an

• rganization’s health and safety management.

Organizations with a positive safety culture are characterized by communications founded on mutual trust, by shared perceptions of the importance of safety, and by confidence in the efficacy of preventive measures.

7

Patients/Famili es and Staff

Engaging Others Ownership, Responsibility, Just Culture Behaviors, Guardian of the Learning System Foundational To Culture Promote environment that supports teamwork

TRUST

The Six Domains

Establish a compelling vision for safety Value trust, respect, and inclusion Select, develop, and engage your Board Prioritize safety in the selection and development

• f leaders

Lead and reward a just culture Establish organizational behavior expectations Leading a Culture of Safety: A Blueprint for Success

Shaping a Culture

• Understand your culture
• Determine the attitudes and beliefs that are shaping the

existing culture “The culture that exists is the culture that you tolerate”

You

Why is a culture of safety necessary to improve patient safety?

• Role of culture in our work: Impact of culture on outcomes

Low Teamwork Score Medium Teamwork Score Medium Teamwork Score

NO blood stream infections for 5 consecutive

Frankel, Safe and Reliable Care

Elements of a Culture of Safety

• Make safety as a core value- establish a compelling vision
• Provide strong leadership at all levels
• Value trust, respect, and inclusion
• Establish organizational behavior expectations- vital behaviors

Elements of a Culture of Safety

• Be reluctant to simplify- focus on the root problem
• Empower individuals to successfully

fulfill their safety responsibilities

BRAVING

• Boundaries – knowing and respecting in self and others
• Reliability - consistency
• Accountability – for own behavior
• Vault – two doors, holding in confidence
• Integrity – courage/comfort, right/easy, practice/profess
• Non-judgement – of self and others
• Generosity – assuming the best but holding to account

Berne Brown, The Anatomy of Trust

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Behaviors expected from leaders at HMC

• Visible
• Approachable and able to engage staff at all levels
• Balanced and just in decision making based on best

evidence

• Patient, Family and Staff focused
• Setting an example as role model for a culture of safety
• Effective communication skills at all levels
• Accountable

Psychological Safety

• “Psychological safety is a belief that one will not

be punished or humiliated for speaking up with ideas, questions, concerns or mistakes.”

• Team members feel safe to take risks and be

vulnerable in front of each other

Amy Edmundson Google Team

Developing Psychological Safety

• Primary responsibility of

leaders, continuously modeled everywhere.

• Leaders model and expect the

behaviors that promote psychological safety

• In some units it feels safe to

speak up and voice a concern

• Personality dependent – it

depends who I’m working with

• Fear based – keep your head

down and stay out of trouble

GENERATIVE

Organization wired for safety and improvement

PROACTIVE

Playing offense - thinking ahead, anticipating, solving problems

SYSTEMATIC

Systems in place to manage hazards

REACTIVE

Playing defense – reacting to events

UNMINDFUL

No awareness of safety culture

What does it take to develop psychological safety?

HMC action

• Close working with Corporate Quality and HHQI
• Action plan linked to the IHI white paper
• Using examples of good practice within the

corporation

• Examining the challenges and evidence to
• vercome
• Engaging staff at all levels with listening and

engagement events

• Ensuring a just culture and system learning is a

key priority for HMC

Accountability

• Each individual is accountable

to others for acting in ways that embody

• rganizational values, and each individual is

accountable as a team member to be committed, self-managing, competent, and courageous

• The organization is accountable for treating

individuals fairly and justly “when things go wrong

Accountability

• Examples: hand hygiene, communicate with

team, follow existing guidelines, etc………

• We know how we will be held accountable for
• ur actions (fair and just culture)

Accountability in a Fair and Just Culture

• Clear and simple rules: “one set” that apply to everyone (no
• ne is “special”)
• Four questions for every situation:
• Was there malice involved?
• Was the individual knowingly impaired?
• Was there a conscious unsafe act?
• Did the person(s) make a mistake that someone of similar skill and

training could make under those circumstances?

• Challenges to anticipate:
• Implementing for all layers of the organization
• Making it “the way we do business”

Michael Leonard, MD - Safe and Reliable

Role of leaders at HMC on developing accountability and a just culture

• Ensuring this remains a corporate priority
• Ensuring these are key values for HMC at all

levels

• Ensuring a consistent approach to review with

the emphasis on system learning.

• This is a cultural journey and will take time to

embed

Teamwork and Communication

Effective Teamwork

REACTIVE

“Safety is important. We do a lot every time we have an accident”

SYSTEMATIC

Systems being put into place to manage most hazards

PROACTIVE

“We methodically anticipate”— prevent problems before they occur

GENERATIVE

Organizational Culture “Genetically-wired” to produce safety

UNMINDFUL

“We show up, don’t we?”

Chronically Complacent

Highly functional teams with systematic, continuous learning Methodical implementation and reinforcement of team behaviors Teamwork tools and training available, partial adoption Awareness and teamwork training after adverse events is the norm Individual expert model – “Just do your job and everything will be fine”

Teamwork Actions

• Huddles
• Plan forward
• Reflect back
• Communicate clearly
• Resolve conflict

Actions of HMC to promote teamwork

• Building Capacity and Knowledge
• Sharing good practice
• Focus on learning culture
• Focus on system wide learning and engagement
• f staff at all levels