Archive March 2017 XVIII, No. 3

Create a Culture of Safety

You know you have one when every member of the surgical team feels comfortable speaking up whenever she sees a potentially unsafe situation.

Bill Donahue, Senior Editor

administrative support SPEAK UP Staff need administrative support to feel free to voice concerns when they see situations that could jeopardize patient safety.

Any OR leader would say even one surgical error is one too many. But how do you get to zero avoidable errors? Sue Dill Calloway, RN, AD, BA, BSN, JD, CPHRM, CCMSCP, says it begins with having an environment where all staff are encouraged to voice their concerns — and feel comfortable doing so — whenever they see a potentially unsafe situation.

Not everyone does, she says, using safe injection practices as an example. Nearly 40% of healthcare professionals who participated in a 2013 Institute for Safe Medication Practices survey said they often felt too intimidated to ask questions or seek clarification over medication orders, even if doing so could have prevented an adverse event.

"If you don't have a culture where people can speak up, you're never going to find out how to fix the problem," says Ms. Calloway, president of Patient Safety and Healthcare Consulting and Education in Dublin, Ohio.

Her point: Creating a open, fair and just environment in which staff can report and discuss errors is no easy task, especially considering historical OR hierarchies, but it's an essential one. Where to begin? Follow these 6 steps.

1. Start at the top. Without administrative support, staff won't feel encouraged to speak up when they see behavior that could endanger a patient's safety. Ms. Calloway uses the example of a nurse refusing to hand a surgeon a scalpel when he hasn't completed a proper time out. "He might run to the administration and say the nurse is keeping him from doing the surgery," she says. "When there's a culture of safety in place, the administration might respond by asking, 'Did you do a time out?' He'll answer, 'Well, no.' 'Then you can't have the scalpel.' If the staff doesn't get that kind of support, they wouldn't feel comfortable doing that."

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