Is It Raining Out There?
An exploration of culture, climate
and safety.
Dr Mike Fray
Loughborough Design School
Overview
Culture and Climate
Safety I and Safety II
Resilience
Indicators for improvements
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Few phrases occur more frequently in
discussions about hazardous
technologies than safety culture. Few
things are so sought after and so little
understood
James Reason, 1997
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Exploring socio-technical systems approach
 Delivery of healthcare services via complex integrated
systems
 Systems Models:
 SEIPS 1.0 and SEIPS 2.0 (Carayon et al 2014),
 Dial F Model (Hignett 2013),
 Dynamic risk and safe performance (Rasmussen1997)
 Consider:
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Role or absence of patient (Mitchell et al 2014)
Active vs passive
Compliant vs non-compliant
Treatment or rehabilitation (Boltz et al, 2012)
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Culture is:
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Emerges through a social process
Staff attach meaning to policy, practice and behaviour
Values, beliefs, assumptions
Created through story, myth and ‘believed success’
Is interpretive

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 Waterson, 2014,
Healthcare Foundation, 2013
5
Climate is:
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Right here right now.
Measureable, observed
Process, practice and behaviour
Influenced by organisational culture
Influenced by organisational procedures
Influenced by individuals at the coal face
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6
Characteristics of a Safe Culture

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Managers engage with safety
Regular clear information on safety
Can raise concerns and will be listened to
Safety is always a top priority
Investigates all accidents and incidents

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HSE 2002
Characteristics of a Safe Culture
 Equipment and training is available if
required
 Everyone is involved in decision making
 Rare for people to take short cuts
 Honest and open about safety
 Morale is generally high

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8
HSE 2002
Consider these items against your
organisation in healthcare, social care,
education, community care?
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Characteristics of a Safe Culture
(For Patient Handling)
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Managers engage with safety (???)
Regular clear information on safety
Can raise concerns and will be listened to (???)
Safety is always a top priority (Against all other priorities)
Investigates all accidents and incidents
Equipment and training is available if required
Everyone is involved in decision making
Rare for people to take short cuts(???!)
Honest and open about safety
Morale is generally high(?)

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HSE 2002
Patient Handling Safety Performance
TROPHI
(Fray and Hignett, 2013)
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Outcome
Rank
Safety culture
12
MS health measures
11
Competence compliance
10
Absence or staff health
9
Quality of care
8
Accident numbers
7
Psychological well being
6
Patient condition
5
Patient perception
4
MSD exposure measures
3
Patient injuries
2
Financial
1
11
Culture to Climate
Organisational
behaviour
measures
(1)
Measures of
safe or quality
behaviour
(3,5,6)
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Measures of
effects on
individuals
(2,4,7,8,9,10,11)
Financial
outcomes
(12)
Are we measuring Culture? Fray Waterson Munro (in press)
Sextons Safety Culture Tool (SAQ) Vs TROPHI (IHI 2012)
OM
SCM
SCScore % +ve
0.50
0.20
0.20
0.20
1 Safety Climate
0.90**
0.70
0.70
0.70
2 MS Health Measure
0.60
0.70
0.70
0.70
3 Competence & Compliance
0.10
0.00
0.00
0.00
5 Quality of Care
-0.21
-0.10
-0.10
-0.10
7 Psychological well-being
0.60
0.70
0.70
0.70
8 Patient Condition
0.90**
0.70
0.70
0.70
9 Patient Perception
-0.20
-0.60
-0.60
-0.60
TROPHI Total
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13
Are we measuring Culture? Fray Waterson Munro (in press)
Sextons Safety Culture Tool (SAQ) Vs TROPHI (ICH 2012)
OM
SCM
SCScore % +ve
0.50
0.20
0.20
0.20
1 Safety Climate
0.90**
0.70
0.70
0.70
2 MS Health Measure
0.60
0.70
0.70
0.70
3 Competence & Compliance
0.10
0.00
0.00
0.00
5 Quality of Care
-0.21
-0.10
-0.10
-0.10
7 Psychological well-being
0.60
0.70
0.70
0.70
8 Patient Condition
0.90**
0.70
0.70
0.70
9 Patient Perception
-0.20
-0.60
-0.60
-0.60
TROPHI Total
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Options to consider
 Paper systems vs actual practice
 Management Commitment
 Work as perceived vs work as done
 What makes a successful transfer
 How do we measure the outcomes of safe patient
handling
 Are we creating positives or avoiding negatives?
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15
 What might the chart represent?
The slice of the chart
represents
1 in 10 000 actions
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0.0001%
Accidents vs safety work
16
Accidents vs safety work
Successful transfers
Against
Serious errors
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Safety I vs Safety II
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Safety I
Accident causation
Understand what goes wrong
Avoid errors
Reduce losses
Safety I and Safety II,
Erik Hollnagel. (2014)
Loughborough Design School
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Safety II
Understand what goes right
Repeat what goes right
Enforce successful behaviours
Develop the ability to create
new process on successful
behaviours
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Gains
Comfort
Good position
Dignity
Perceived safety of patient
Efficiency
Rehabilitation
Clinical gains/maintenance
18
Safety and Resilience
 Oxford English Dictionary
 Recoil or spring back into shape
 Withstand or recover quickly from difficult conditions
 Organisational Resilience (Vogus and Sutcliffe 2007)
 ‘positive adjustments under challenging conditions’
 ‘vitally prepared for adversity which requires improvement in
overall capacity’
 Concept of ‘Brittleness’ (Prof Woods, Ohio State)
 Boundaries of performance
 Graceful extensibility
 Sustained adaptability
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Rasmussen’s Dynamic Risk Model (1997)
 Outline
 Operating Point
 Acceptable
Performance
 Unacceptable
workload
 Boundary to
economic failure
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Patient Handling Risks (NBE 2014, Gallagher 2012)
Responses:
1. Increase infrastructure
2. Increase staff numbers
3. Do nothing
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Patient Handling Safety Climate Fray Waterson Munro
(in press)
Observed Intervention Measures. Communication
systems, supervision, education and training, safe
equipment and environments
Perception of Effectiveness.
Recording the responses of all affected
by the process, managers, supervisors,
staff and patients
'Patient
Handling
Climate'
Outcome Measures. Specific
measures showing the effects of the
process e.g. levels of incidents,
musculoskeletal losses, quality of care
measures, productivity, throughput etc .
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Looking wider for possible solutions.
 Ergonomics and Human Factors Short courses.
 Human Factors Concordat (2012)
 Health Education England (2015)
 Other providers
 MSc Ergonomics (Health and Community Care)
 Certificate, Diploma, Masters
 Accreditation for Back Care Management
 Update modules for all.
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Ergonomics and human factors has some
answers but as Johnny Nash once said
‘There are more questions than answers’
M.J.Fray@lboro.ac.uk
Loughborough Design School