Want better outcomes? Establish culture of safety
Would you like to have better care, teamwork, communication, workflow, and staff/ patient satisfaction, along with fewer frustrations? These outcomes can be achieved with a culture of safety, says Ann Shimek, MSN, RN, CASC, senior vice president, clinical operations at United Surgical Partners International in Addison TX. Shimek spoke on "Establishing a culture of safety in your ASC" at the recent Ambulatory Surgery Center Association (ASCA) annual meeting.
In a culture of safety, every employee has a role in patient safety and can speak up anytime to "stop the line," which means the procedure is stopped. As lessons are learned, they are communicated to the staff to prevent future errors.
A culture of safety is an environment in which safety incidents and errors are discussed openly rather than taking a punitive response, which minimizes reporting, Shimek says. A culture of safety encourages employees to report errors or "good catches" caught before an error occurs without fear of retribution, she says. The focus of blame is on processes, not people.
Shimek suggests these steps to establish such a culture:
• Create a culture of safety team.
Include representatives of departments including the business office, preop, and materials management. Encourage the medical director to attend these meetings, Shimek advises. Have the team meet monthly, and buy lunch, she suggests. Have the team members report their progress as well as concerns they are addressing, Shimek says.
Also, designate a culture of safety champion. This person should be passionate about the topic and willing to learn as much as possible, she says. Also, this person should be willing to share their enthusiasm with employees.
• Educate your staff and doctors.
In addition to educating employees and physicians, include contract and agency personnel, Shimek says. Perform the education at orientation, and conduct annual competency training. Go over the adverse events that are reported, how to report the events, and the importance of reporting good catches, Shimek says.
"Some centers are having employees sign an attestation that says, I agree to support a culture of safety and help avoid wrong-site surgery.’"
• Encourage staff and physician involvement.
Dedicate a monthly staff meeting to the culture of safety. Acknowledge and reward staff members for reporting "good catches" made before they reach the patient.
Also, review the culture of safety with the medical director. Report results of your efforts on an ongoing basis to the medical executive committee and the governing board, Shimek advises. Also include the culture of safety as an agenda item at the medical staff meetings, and report your results, she says.
Have a box for anonymous reporting of safety concerns and suggestions on how to improve patient care and outcomes, Shimek says. Review these suggestions on a regular basis with the staff, she says.
• Have leadership rounding.
Leaders should round every department at least once a day, and they should vary the times they round, Shimek says. Ask employees and physicians about any safety concerns they have, she says. Make sure staffing is adequate and that they have the tools and resources they need, Shimek says.
• Have a stop-the-line policy.
Make sure your employees know they are supported if they want to "stop the line" and question patient safety. Establish a direct phrase that all employees and physicians are educated to use. For example, with a potential wrong medication dose, employees can say, "I need clarification that this is the correct dosage." They can repeat the phrase if needed. If the process is not discontinued immediately, then the employee can call the manager and state, "I have a stop-the-line event."
"If you’re not being called, it’s not working," Shimek says. "The most key part is that the manager drops everything to support the employee."
