Enhancing safety protocols and measurements are important for a number of industries, but in healthcare, a strong safety culture has life and death consequences, as well as multiple implications for key business outcomes, including staff retention and patient satisfaction scores.
To understand the implications and how to measure safety culture, first you have to understand what it means – by definition and in your organization.
What is Safety Culture?
Safety culture is defined as an organization’s shared perceptions, beliefs, values, and attitudes that combine to create a commitment to safety and an effort to minimize harm. While safety has been a long-standing priority for the healthcare field, many healthcare systems and facilities are achieving better safety through a high-reliability framework. High-reliability principles were developed initially based on studies of other high-risk industries, such as nuclear power and aviation. Often described as high-reliability organizations (HROs), these companies work continuously to minimize accidents or safety events from occurring during their complex and hazardous work. For high-reliability organizations, the culture of safety is emphasized and prioritized throughout all levels of the business, from front-line workers to managers, administrators, and executives.
When it comes to becoming a high-reliability organization in healthcare, the Joint Commission developed a framework for healthcare organizations to follow. It includes:
- The leadership must be committed to the goal of zero harm.
- There should be a culture of safety in which all staff feel as though they can speak up and bring attention to issues or challenges that may reflect negatively on the organization without fear of retribution.
- The workforce must be empowered to employ Robust Process Improvement (RPI) tools to address improvement opportunities that could result in significant and lasting change. (RPI is a combination of Lean Six Sigma and change management that addresses performance improvement, including efficiency, empowerment, quality, and behavior.)
The Importance of a Culture of Safety in Healthcare
For healthcare organizations, creating a safety culture has numerous benefits. It makes the work environment better for all staff members. It improves the patient experience, and it has a positive effect on business outcomes as well. Consequently, it is no surprise that safety culture is a top priority for healthcare organizations.
With patient safety being at the center of a safety culture, many organizations try to emphasize the human aspect of what they do and why it is important to be safety-minded. For instance, in many healthcare organizations, they showcase their safety culture through patient stories. By highlighting a success with a patient, even if it started from a misstep or a preventable harm situation, it helps their staff members relate to that patient and that story and show the organization makes patient-centered decisions. It also emphasizes the importance of bringing forward areas of concern or mistakes – so they are used as a learning opportunity and allow better systems to be put in place as a preventative measure.
Another reason safety has become such a priority is because preventable harm (which could be medication dosage errors, in-hospital infections, medical errors, surgical equipment malfunctions, etc.) is incredibly expensive for healthcare organizations. According to a report published on the National Center for Biotechnology Information website, an estimated 400,000 hospitalized patients experience some type of preventable harm annually while 200,000 people die each year due to a medical error. This equates to approximately $20 billion a year in healthcare costs for hospitals/healthcare systems.
When employees feel safe, supported, and cared about at work, they provide better care to patients, and when patients receive better care, they report higher satisfaction levels overall. There is a clear reciprocal relationship between the patient experience and the employee experience. As a matter of fact, recent research from Perceptyx found that healthcare facilities that perform well in commitment to safety, collaboration, and recognition are 2.5 times more likely to have a 5 overall hospital star rating. Therefore, prioritizing patient-centered decisions and a strong safety culture pays off.
What We Can Learn from Safety Culture Surveys
Now that the benefits of a safety culture are known, it is important to understand how it is measured. Many organizations utilize some version of the Agency for Healthcare Research and Quality (AHRQ) patient safety surveys, primarily Hospital 2.0, to create their patient safety scores. Often administered by third-party vendors, including Perceptyx, these surveys comprise employee responses to develop the scores.
Typically, questions regarding patient safety culture are used to determine the belief, values, and norms shared by healthcare staff. This survey will also determine what workplace behaviors are rewarded, supported, expected, and accepted among each job role throughout the organization – at the system, hospital, department, and unit levels.
Organizations that take part in the Hospital 2.0 survey have the option to submit their findings to the SOPS Hospital Database. By doing this, it helps create benchmark data for other healthcare organizations to learn from and compare to. The 2021 SOPS Hospital 2.0 User Database Report, comprises the first voluntarily submitted 2.0 survey data from 172 hospitals and includes 87,856 provider and staff respondents, all of which were collected between November 2018 and October 2020. Notably, 85% of the surveys were administered during the COVID-19 pandemic (March 2020-October 2020), which likely had an impact on survey scores.
From the compiled results, the survey found that teamwork and supervisor, manager, or clinical leader support for patient safety scored the highest and were areas of strength for most hospitals at 82% and 80% respectively. However, it also discovered areas that needed improvement across most hospitals. Only 58% of respondents said there is enough staff to handle the workload, they work appropriate hours, and their reliance on temporary, float, or PRN staff is appropriate, meaning that 42% of respondents were neutral or disagreed. Additionally, 64% of respondents indicated that there is adequate sharing of important patient care information during shift changes. Overall, the database reports that 69% of respondents rate their unit/work area as excellent or very good, leaving 31% in good, fair, or poor territory. To truly live a safety-focused culture, these scores have room for improvement.
Stay tuned for a follow-up blog on the common barriers to implementing a safety culture and how to combat them.