Patient safety is a core concept to professional nursing practice. Indeed, we have an ethical responsibility to keep our patients from harm and to always seek their good. I discuss this in an earlier post. Wouldn’t it be nice if we could just say – OK, patient safety is a great model – Let’s do it! Unfortunately, changing a mindset is difficult in any setting; maybe even more so in an entrenched correctional culture.
There are many reasons it can be challenging to embark on a serious journey toward a patient safety culture in a correctional setting. Here are the three frequent barriers to advancing a patient safety model that I found while working with health care leaders in jails and prisons. Would these be barriers in your facility?
An organization’s culture is the collection of norms of behaviors that are approved, allowed, or ignored. Culture determines what behaviors are rewarded and what behaviors are punished. Many work cultures in the criminal justice system are built on incivility and disrespect. These cultures are more likely to reward conforming and ‘by the book’ behaviors that rely on administrative controls rather than innovation and initiative. Leaders in this type of environment do not want to hear the ‘bad news’ of a possible safety issue and may marginalize those who try to make them aware of concerns that need addressed to avoid harm.
On the other hand, a patient safety culture builds on a culture of respect and is non-punitive in nature; valuing accountability, honesty, and mutual respect. This has been described as “allowing the boss to hear bad news”. A patient safety culture, then, requires open communication based on trust and positive regard, not always present in our hierarchical and para-military settings.
Another common barrier to implementing a patient safety mindset is broken or absent systems. Health care, in and of itself, is a complex system of interactions of care providers, patients, diagnostics, equipment and environment. Correctional health care is all of that with an overlay of the criminal justice system and security structure. Not only is health care a complex system but also one that is constantly adapting to changing context and outcomes.
We are in a high-stakes profession where broken systems can mean loss – injury and death – as this case in a prior post illustrates. Human error is inevitable. We must admit that and embrace it to move forward in designing our health care processes and systems to limit and avoid human error potential.
There are many more barriers to a patient safety perspective in corrections but I will close with just one more – Nobody Cares. Granted, there is good reason for developing an uncaring attitude toward our work and our patients. After all, it only takes being manipulated or duped by a patient to be on guard against that happening again. No one wants to be on the other end of deception or exploitation.
Even as healers, we can absorb a pervading “us against them” mentality in many of our settings. If cynicism does not harden our souls, maybe compassion fatigue or secondary traumatization from working with patients in such distressing life situations can zap energy and leave us focusing on merely performing tasks without really considering the people we care for. Layered upon this can be the challenges of dealing with uncivil or bullying peers. All of this can lead to a ‘why bother’ attitude toward our role in patient care and patient safety.
Yet, only clinicians thoughtfully considering their practice and environment will actually see and respond to potentially harmful situations. Only engaged practitioners will reflect on a patient situation to improve the care they provide.
Does this paint a hopeless picture regarding patient safety? I hope not! No matter what your position, you have an opportunity to make a difference and move the organization forward toward patient safety.
Great things are done by a series of small things brought together. – Vincent Van Gogh
What is a small step you could take toward a patient safety culture in your setting? Share your thoughts in the comments section of this post.