Creating a Culture of Safety for Nurses and Patients
Ensuring the safety and well-being of patients and staff is crucial to the success of a healthcare organization, not just because of legal, regulatory, and reimbursement obligations, but because doing so is in the hospital’s best interest and it's the right thing to do. Unsafe facilities are stressful environments that accelerate staff burnout, moral injury, and turnover; jeopardize patient safety; and result in a poor patient experience and bad reputation and outcomes for the facility.
Nurses compose the largest provider group that spends the most time in patient-facing roles. As a result, prioritizing the creation and maintenance of a safe environment for nurses and patients alike should be the goal for all healthcare organizations. But often, achieving that goal is easier said than done. In this blog, we’ll explain why creating a culture of safety and engaging nurses in doing so is the first—and most important—step toward building a safe environment for all in today’s complex healthcare enterprises.
Worrisome statistics about nurses—our most prolific caregivers
A COVID-19 longitudinal report by the American Organization for Nursing Leadership stresses why organizations must support their nurses now, more than ever. Of 2,471 nurse leader respondents:
What is a culture of safety?
A culture of safety culture can be described as the shared perceptions, beliefs, values, and attitudes that combine to create a commitment to safety and a continuous effort to minimize harm. The keywords are shared and combine: Every staff member at a facility can be individually safety-oriented, but without collaboration, communication, and a unified sense of purpose, a culture of safety can’t exist.
A culture of safety doesn’t just protect nurses and other providers and patients from physical harm, but also safeguards them from psychological harm. Studies have shown that a positive safety culture can improve patient safety and patient outcomes. Conversely, an environment that makes staff feel uncomfortable can be as detrimental to patient safety as one in which staff fear for their physical safety.
Defining a culture of safety is the easy part. But how can healthcare leaders go about creating and maintaining one? Every organization has unique challenges, but there are well-established models and training tools for promoting safety.
Build a strong foundation of safety
Instilling a culture of safety within an organization is not an overnight process. Many healthcare organizations fall short in their efforts to improve safety for nurses and patients for one simple reason: they focus on changing policies, not behaviors. Facility leaders must foster an environment that encourages staff to prioritize safety for their patients and colleagues—not because they are required to, but because they want to.
To lay the foundation for cultural change in an organization, facility leaders must encourage the following staff behaviors:
Foster team communication
In a culture of safety, staff members view safety as a collective responsibility rather than an individual one, and effective communication is pivotal. Nurses, as a result of their close proximity to patients, must feel especially comfortable flagging existing or potential safety risks to every member of the team.
Open communication across multiple levels is crucial, too. On healthcare teams it’s common for each member to assume someone else is in charge of managing safety, which often results in everyone being aware of an issue—and nobody taking the necessary steps to address it. In other words, safety is everyone's responsibility.
Encourage incident and error reporting
The overarching goal for healthcare organizations is safety, but a fear of failure doesn’t make a facility safer. Errors often go unreported due to a fear of disciplinary action. Encourage staff to speak up when they see errors or improvement opportunities. If they aren’t supported in doing so, hospitals will miss out on valuable safety feedback from those who are in the best position to provide it.
Facility leaders must make it clear that reporting incidents about near misses will not lead to negative repercussions, except in cases involving extreme carelessness or negligence. Today’s technology makes it easier than ever to turn near misses into sustainable improvements in staff and patient safety and quality by carefully analyzing incident reports about “good catches.” In fact, some facilities reward good catches and use this information to rethink the faulty process.
Patients also play a role. Providers and healthcare administrators, such as quality directors, should actively seek out feedback from patients about the care they’re receiving and how they’re feeling. And, for example, patients and their families can serve as partners in monitoring staff compliance with safety protocols. As in staff reporting, patient-feedback management can turn complaints into true safety improvements.
How leaders can emphasize safety
Creating a culture of safety must be a top-down effort. If facility leaders give the impression that safety is not a priority, nurses and other clinical staff will assume it isn’t—and so will their patients. Facility leaders emphasize the importance of safety in a number of ways.
Regularly review safety reports
Safety reports yield a number of valuable insights that can help facilities strengthen their safety practices, but only if there’s a designated party to review them and share the results. Facility leaders should make a habit of regularly reviewing and discussing safety reports with nurses and other clinical staff, both in individual and team settings.
Bringing nurses into the discussion sends a clear message that their safety, and that of their patients, is a priority, and gives hospital administrators the opportunity to get a fresh perspective on how to approach ongoing safety issues.
Create Rapid Response Teams
At least one in 10 patients has experienced an adverse event in a clinical setting, and studies suggest that at least 50% of adverse events are preventable. While a strong culture of safety can reduce preventable adverse events, unfortunately human and system errors will result in incidents and errors that are unavoidable and unforeseeable.
Creating a Rapid Response Team (RRT) gives nurses and other staff the opportunity to practice how they respond to adverse events. Creating and drilling an RRT encourages teamwork and communication and helps to ensure that when—not if—an adverse event occurs, clinical staff are prepared to respond quickly and effectively with the help of the RRT.
Perform safety rounds with clinical nursing staff
One challenge hospital leaders face when trying to get buy-in from nurses and other clinical staff on cultural change is the perception that leaders don’t understand the challenges clinical staff navigate daily. Nurses don’t expect administrators to be able to jump in when a patient experiences an adverse event, of course, but they do expect leaders to understand how proposed safety protocols or initiatives affect patient care at the bedside.
Facility leaders—and not just the chief nursing officer—should perform regular safety rounds with nurses and other clinical staff, walking the floors during their shifts, and engaging honestly and openly afterward with them about their safety concerns. Such facetime with hospital administrators gives rank-and-file nurses and other clinical staff an opportunity to highlight safety concerns that leadership can address before they become a larger issue.
Invest in safety
If providers and other staff highlight a need for equipment, software, supplies, etc., facility leaders should do their best to meet that need. The costly consequences of failing to do so were exposed during COVID-19, with a lack of personal protective equipment.
Remember, a culture of safety can exist only when everyone works toward the same goal—and that includes leaders. If nurses and other clinical staff members feel unsupported in their efforts to build and preserve a safe environment for all, it won’t be long before the facility’s safety standards begin to slip.
For more information on how symplr can help your facility or organization achieve a safer environment for nurses, patients, and every participant across the care continuum, visit the symplr Patient Safety solutions page.
About Dr. Karlene Kerfoot
As CNO, Karlene is responsible for integrating the science of patient care, staffing, and clinical informatics into symplr solutions. Prior to joining symplr in 2011, she was the Corporate Chief Nursing and Patient Care Officer at three of the largest US healthcare systems. Previously she held positions in clinical practice, healthcare consulting, project management and academic appointments in Business Administration and Nursing. She holds a PhD from the University of Illinois, Chicago, an MA and BSN from the University of Iowa and has completed executive leadership programs at the Wharton School for Nurse Executives. Karlene has published over 400 articles in the areas of data-driven staffing, workforce management, leadership and patient safety. She writes a popular column on leadership for Nursing Economic$ and serves on the DAISY Foundation Board. She was elected as a Fellow to the American Academy of Nursing (FAAN), and has received numerous awards and honors.