Teaching the Culture of Safety
Teaching the Culture of Safety
Although a healthcare culture of safety has been a practice priority for many years, there has been less attention to incorporating culture of safety content into the education of healthcare professionals. Students need to become knowledgeable about system vulnerabilities and understand how knowledge, skills, and attitudes promoting utilization of safety science will lead to safer care for patients and families. Learning about both patient safety and system vulnerabilities needs to begin in pre-licensure programs and become an integral part of learning in all phases of nursing education and practice. In this article the author will begin by reviewing the essential elements of a culture of safety and considering what students need to know about a culture of safety. She will describe activities that promote safety, high reliability organizations, and external drivers of safety, and conclude by offering strategies for integrating a culture of safety into the curriculum.
Although the goal of a culture of safety is to lessen harm to patients and providers through both system effectiveness and individual performance (Cronenwett et al., 2007), numerous threats to patient safety remain and errors occur at all interfaces of care delivery. Common obstacles to a safe system include complex and risk-prone systems that produce unintended consequences; lack of comprehensive verbal, written, and electronic communication systems; tolerance of stylistic practices and lack of standardization; fear of punishment which inhibits reporting; and lack of ownership for patient safety. Nurses need to be knowledgeable about system vulnerabilities and understand how knowledge, skills, and attitudes promoting the utilization of safety science will lead to higher quality care for patients and families (Finkelman & Kenner, 2009).
It is important to recognize that errors can take place across the healthcare system. Latent failures, sometimes called the 'blunt' end, arise from decisions that affect organizational policies, procedures, and allocation of resources. One example would be the purchasing department's ordering a new type of intravenous pump without input from front-line clinicians. Active failures occur at the interface of contact with the patient, for example during medication administration. These errors are sometimes referred to as the 'sharp' end. Organizational system failures, or indirect failures, are related to management, organizational culture, protocols/processes, transferring of knowledge, and external factors, for example decisions regarding staffing and scheduling. Technical failures are the indirect failure of facilities or external resources (Reason, 2000).
The Institute of Medicine (IOM) has worked to move our emphasis from addressing errors to promoting safety through widespread system changes. The Institute of Medicine (IOM) has worked to move our emphasis from addressing errors to promoting safety through widespread system changes. The message in To Err is Human was to prevent, recognize, and mitigate harm from error, defined as, the "failure of a planned action to be completed as intended … or the use of a wrong plan to achieve an aim" (Kohn, Corrigan, Donaldson, 2000, p.28). Developing a culture of safety in learning organizations, understanding the limits of human factors, and appreciating the reasons for comprehensive reporting mechanisms are all essential components in the preparation of nurses to be participants in 21 Century healthcare (Berwick, Calkins, McCannon, & Hackbarth, 2006). Learning about both patient safety as a fundamental quality of patient care and system vulnerabilities needs to begin in pre-licensure programs and be an integral part of learning in all phases of nursing education and practice (Cronenwett et al., 2007, Cronenwett et al., 2009).
In this article I will begin by reviewing the essential elements of a culture of safety and considering what students need to know about a culture of safety. Then I will describe activities that promote safety, high reliability organizations, and external drivers of safety, and conclude by offering strategies for integrating a culture of safety into the curriculum.
Abstract and Introduction
Abstract
Although a healthcare culture of safety has been a practice priority for many years, there has been less attention to incorporating culture of safety content into the education of healthcare professionals. Students need to become knowledgeable about system vulnerabilities and understand how knowledge, skills, and attitudes promoting utilization of safety science will lead to safer care for patients and families. Learning about both patient safety and system vulnerabilities needs to begin in pre-licensure programs and become an integral part of learning in all phases of nursing education and practice. In this article the author will begin by reviewing the essential elements of a culture of safety and considering what students need to know about a culture of safety. She will describe activities that promote safety, high reliability organizations, and external drivers of safety, and conclude by offering strategies for integrating a culture of safety into the curriculum.
Introduction
Although the goal of a culture of safety is to lessen harm to patients and providers through both system effectiveness and individual performance (Cronenwett et al., 2007), numerous threats to patient safety remain and errors occur at all interfaces of care delivery. Common obstacles to a safe system include complex and risk-prone systems that produce unintended consequences; lack of comprehensive verbal, written, and electronic communication systems; tolerance of stylistic practices and lack of standardization; fear of punishment which inhibits reporting; and lack of ownership for patient safety. Nurses need to be knowledgeable about system vulnerabilities and understand how knowledge, skills, and attitudes promoting the utilization of safety science will lead to higher quality care for patients and families (Finkelman & Kenner, 2009).
It is important to recognize that errors can take place across the healthcare system. Latent failures, sometimes called the 'blunt' end, arise from decisions that affect organizational policies, procedures, and allocation of resources. One example would be the purchasing department's ordering a new type of intravenous pump without input from front-line clinicians. Active failures occur at the interface of contact with the patient, for example during medication administration. These errors are sometimes referred to as the 'sharp' end. Organizational system failures, or indirect failures, are related to management, organizational culture, protocols/processes, transferring of knowledge, and external factors, for example decisions regarding staffing and scheduling. Technical failures are the indirect failure of facilities or external resources (Reason, 2000).
The Institute of Medicine (IOM) has worked to move our emphasis from addressing errors to promoting safety through widespread system changes. The Institute of Medicine (IOM) has worked to move our emphasis from addressing errors to promoting safety through widespread system changes. The message in To Err is Human was to prevent, recognize, and mitigate harm from error, defined as, the "failure of a planned action to be completed as intended … or the use of a wrong plan to achieve an aim" (Kohn, Corrigan, Donaldson, 2000, p.28). Developing a culture of safety in learning organizations, understanding the limits of human factors, and appreciating the reasons for comprehensive reporting mechanisms are all essential components in the preparation of nurses to be participants in 21 Century healthcare (Berwick, Calkins, McCannon, & Hackbarth, 2006). Learning about both patient safety as a fundamental quality of patient care and system vulnerabilities needs to begin in pre-licensure programs and be an integral part of learning in all phases of nursing education and practice (Cronenwett et al., 2007, Cronenwett et al., 2009).
In this article I will begin by reviewing the essential elements of a culture of safety and considering what students need to know about a culture of safety. Then I will describe activities that promote safety, high reliability organizations, and external drivers of safety, and conclude by offering strategies for integrating a culture of safety into the curriculum.
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