What make 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

"Changing your practice culture and increasing staff awareness can make a positive and measurable difference to patient safety"

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:

• 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.

What should you do to build a safety culture?

• Undertake a baseline cultural survey of your practice
• Undertake a risk assessment to identify potential risks to patients and staff
• Appoint a risk manager for the practice
• Develop effective leadership, ie, lead by example, and demonstrate that you are sincerely committed to safety
• Encourage team working – build ownership of patient safety at all levels and exploit the unique knowledge that employees have of their own work
• Develop a structured approach to safety
• Ensure effective communication with the team and patients
• Learn lessons from complaints and mistakes – remember we will all make mistakes (to err is human) but the key is to learn from those mistakes and ensure that systems are robust so that errors are less likely to happen
• Ensure that staff are trained to competently undertake the roles assigned to them.

Is your practice safety culture up to scratch?

Changing your practice culture and increasing staff awareness can make a positive and measurable difference to patient safety.

MPS’s Safety Culture 360° is a unique validation tool that covers four key areas of patient safety. It brings practice staff together to understand and enhance the safety culture within your practice.

Take our online survey today and benchmark your practice against the 850 that have already taken part.

Summary

The correlation between safety culture and patient safety is dynamic and complex. Healthcare is not without risks and errors and incidents will occur. General practice should work to minimise those risks by ensuring systems are robust and that when things do go wrong, lessons are learnt and appropriate action is taken. By developing a team approach to patient safety, it will in turn develop the safety culture of your practice and improve the quality of care provided.

"By developing a team approach to patient safety, it will in turn develop the safety culture of your practice and improve the quality of care provided"

References

1. World Nuclear Association Chernobyl Accident 1986 (2009)
2. NPSA, Seven Steps to Patient Safety in Primary Care (2009).

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