Tony Kelly & Kay Mackay

Can improving safety culture improve outcomes for patients?

Can improving safety culture improve outcomes for patients?
……organisations need to put the patient at the centre of all they do, get smart intelligence, focus on improving organisational systems, and nurture caring cultures by ensuring that staff feel valued, respected, engaged and supported.

What is safety culture?
Safety Culture
A global phenomenon and encompasses the norms, values, and basic assumptions of an entire organisation.
Safety Climate
Climate, on the other hand, is more specific and refers to the employees’ perceptions of particular aspects of the organisation’s culture.

How can you measure safety culture?

“In all studies of culture in health care, dominant hierarchical cultures, characterised by a preoccupation with target setting, rules, regulations and status hierarchies never predict good performance.

“In all studies of culture in health care, dominant hierarchical cultures, characterised by a preoccupation with target setting, rules, regulations and status hierarchies never predict good performance.
Instead, they potentially inhibit a positive climate for safety due to fear of negative outcomes and blame for reporting safety-related
problems”.
West 2015

Can quality vary depending on your viewpoint?
• Patient
• Healthcare professional
• Organisational
• System/health economy
• National
It also depends on where in the system you sit

Can culture vary depending on your viewpoint?
• Patient
• Healthcare professional
• Organisational
• System/health economy
• National
It also depends on where in the system you sit

Can culture vary depending on your viewpoint?

Why is culture so important?
“that culture will trump rules, standards and control strategies every single time”
Berwick 2013
“Safety culture is more than just a subset of organisational culture. It is made up of the different sub-cultures that exist within healthcare organisations at the frontline, management and executive level or
layer”
Health Foundation 2013

Which areas are we focusing on?

What are the key questions to address?
1.
Do we have a robust method for assessing safety culture and climate?
2.
Do organisations have sufficient capability to understand the information produced and make improvements?
3.
Do organisations have sufficient capability to effect the changes required?
4.
Do Trust boards have sufficient understanding of how to effect culture change in their own organisations?

How does safety culture evolve?
Agreeing shared values, purpose & ways of working together
Values Agreed
Talking about purpose & values
Values
Espoused
Challenging & supporting each other to live the shared values and purpose
Values Lived
Embedding shared purpose & values in systems. “form follows function”
Values Embedded

How should you measure safety culture?

KSS PSC
Provider
Requires Trust ‘permission’ to engage in process and recognition that they will need to work with the information gained and support staff involved
Front line team assessments

KSS PSC
Requires Board ‘permission’ to engage in process and recognition that they will need to work with the information gained and support staff involved
Provider
Front line team assessments
Organisation needs to identify suitable front line teams to engage with
Front line team need to be ‘signed‘ up to participate

KSS PSC
Provider
Front line team assessments
Culture tool
The PSC will develop and provide a validated culture tool and the mechanism to do the assessments
(and/or can support us of the
Trust’s own tool)

KSS PSC
Provider
Front line team assessments possible lines of feedback
Facilitation support
The PSC will provide skilled facilitation of the outputs from the assessments. This information is provided back to the teams in the first instance and also back to the Trust where appropriate.
Post assessment workshops

KSS PSC
AHSN/EQ
Interaction with established
EQR or PSC pathways at front line to provide improvement support and or share learning where needed
Provider
Front line team assessments feedback & capability development
Post assessment workshops
Improvement cycle

KSS PSC
Provider
Front line team assessments recycle capability
Post assessment workshops
Facilitation support
PSC provides (&/or commissions) staged facilitation to both develop and support internal faculty development to deliver further assessments
Faculty development
Improvement cycle

Provider A
Faculty development
PSC provides network to share faculty to both aid support of new sites and provide peer-support between sites and share learning
Provider B
Faculty development
Front line team assessments
Post assessment workshops
Front line team assessments

What assumptions are we making about providers?
• They know what is the right thing to do?
• They have the means to implement the changes required?
• They have the time to implement the changes required?
• They understand the barriers to change?
• They have the capability to implement the changes required?

What assumptions are we making about our systems ?
• We know what is the right thing to do?
• We have the means to implement the changes required?
• We have the time to implement the changes required?
• We understand the barriers to change?
• We have the capability to implement the changes required?

How do we take this work forward?
• Does this resonate with you as a problem?
• Does this feel like an attractive model?
• What do you foresee as the potential barriers?
• How can or should this be adapted for use in other sectors?