Work culture is created by the values, attitudes, perceptions and behaviors of the work team. It is most simply defined as ‘the way we do things here’ and grows over time to be a stable presence in the life of an organization. The prevailing work culture in corrections can be militaristic and punitive. Creating a culture of patient safety in the correctional setting is challenging but rewarding.
Elements of a Safety Culture
According to the Institutes of Medicine’s Patient Safety publication, there are 5 key components to a culture of safety. These elements can be applied to correctional health care to move us toward a culture that advocates for patient safety at all levels.
- Shared beliefs and values – All staff, and particularly site leadership, must share a value of patient safety and its central importance to care delivery. As much as we seek error-free practice, human systems mean errors are going to happen. “However, hazards and errors can be anticipated, and processes can be designed both to avoid failures and to prevent patient harm when a failure occurs” (IOM, 2004, pg 175). Patient safety should be seen as an investment rather than a cost.
- Recruitment and training with patient safety in mind – Much of our orientation of new staff is focused on necessary procedures and tasks involved in the position. Orientation programs need to be revisited with an eye toward a patient safety perspective.
- Organizational commitment to detecting and analyzing patient injuries and near misses – openness about errors and near misses can be particularly threatening in correctional health care. A culture of silence can exist that thwarts efforts to uncover system and clinician error. Once detected, injuries and near misses need adequate analysis to determine root causes and make system changes that will support safe patient care. This can be hard work and a punitive culture may wish to assign blame to individuals rather than seek to improve safety systems.
- Open communication regarding patient injury results – This open communication is needed in order to truly improve the system. Once again, transparency is challenging in our care setting. Some systems may value the appearance of error-free work while hiding the actual reality of human systems.
- A just culture – A just culture is a component of an overall safety culture that seeks a balance of learning from mistakes while taking disciplinary action when appropriate. Although many errors are the result of system flaws, inadequate processes or lack of training; some errors are caused by negligent or reckless behavior. A just culture differentiates among the causes of error and intervenes appropriately.
Organizations with a positive safety culture have several characteristics in common including staff communications founded on mutual trust, shared perceptions of the importance of safety, and a confidence in the safety systems that are in place. When patient safety is perceived as important, staff members are more willing to take personal responsibility for safety and act to preserve patient safety when it is jeopardize. Within a context of mutual trust, staff are willing to communicate safety concerns and modify behavior based on lessons learned from mistakes. And, confidence in the safety systems in place allows staff to focus on their primary roles while seeking additional safety enhancements to add reliability to the system.
According to the IOM, moving an organizational toward a patient safety culture can result in reduced clinical error and improved patient care outcomes. That is good news for our correctional health care settings.
Read more about Patient Safety in Chapter 4 from Essentials of Correctional Nursing. Order your copy directly from the publisher. Use promotional code AF1209 for $15 off and free shipping.
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