What makes a patient safety culture?

MPS Clinical Risk Programme Manager Julie Price discusses how to build a patient safety culture in primary care

Everyone can think of a successful team: whether it be rugby, football, or cricket. But what characteristics do successful teams have to make them a winning combination?

How does good team-working translate into general practice? It is striving together for high quality and a safe service. Quality starts with safety – let us not forget the Hippocratic principle: “First, do no harm”. How do you achieve this? Your practice may have fantastic individuals, but to meet these aims you must have a team safety culture.

What is a safety culture?

Safety within an organisation is dependent upon its safety culture. This concept was first coined by the nuclear power industry in the aftermath of the Chernobyl accident in 1986. Following an error during the testing of a reactor, a radioactive cloud was discharged which contaminated much of Europe – an estimated 15,000 to 30,000 people died in the aftermath.¹

Of course, first thoughts are to blame the plant operators – they made a mistake – but as with most disasters when things go wrong it is rarely because of a single isolated event.

Errors and incidents occur within a system and usually there is a sequence of events that occur before an accident happens.

With Chernobyl, investigators found that the disaster was the product of a flawed Soviet reactor design coupled with serious mistakes made by the plant operators. It was a direct consequence of Cold War isolation and the resulting lack of any safety culture.²

For example:

• The reactor was operated with inadequately trained personnel.
• The team was not competent to do the job; they were electrical engineers rather than specialists in nuclear plants.
• There was poor communication between the team and managers.
• The nuclear reactor was housed in inappropriate premises.

The Advisory Committee on the Safety of Nuclear Installations 1991 stated that: “The safety culture of an organisation is the product of individual and group values, attitudes, perceptions, competencies and patterns of behaviour that determine the commitment to an organisation’s safety management.”

Developing a safety culture

This learning can be translated into the context of healthcare. A safety culture in primary care can be described as possessing the following characteristics:²

• Individuals and teams have a constant and active awareness of the potential for things to go wrong.
• A culture that is open and fair and one that encourages people to speak up about mistakes – being open and fair means sharing information openly with patients and their families balanced with fair treatment for staff when an incident happens.
• Both the individual and organisation are able to acknowledge mistakes, learn from them and take action to put them right.
• It influences the overall vision, mission and goals of the team or organisation, as well as the day-to-day activities.

The systems approach to safety acknowledges that the causes of a patient safety incident cannot simply be linked to the actions of the individual staff involved. All incidents are also linked to the system in which the individuals are working.