by Jack Egnatinsky, MD
As an AAAHC-accredited center, you must comply with the Core Standards in Chapter 5-II, Risk Management and Chapter 7-II, Safety. You may have a freestanding safety program or one integrated into your risk management program. But do you have a culture of safety throughout your organization? If you answered “no” or “I don’t know” then you have to elevate safety, of patients and staff, to one of your top priorities.
The National Quality Forum’s Safe Practices for Healthcare and the Leap Frog group both require hospitals to assess their “safety culture”. Our standards require that you assess your programs, but not your “culture.” So what does this all mean? In industry there are “high reliability” companies. We don’t have a similar designation.
Every aspect of your operations, from initial patient encounters to follow-up care, should focus on doing things right: avoiding errors; reporting all errors or lapses no matter how minimal; reporting near misses and establishing an environment of establishing trust amongst all of your staff; a non-punitive, blame-free system for reporting; a thorough review of all “events,” no matter how trivial; and development of processes or systems to achieve your goal of a safe high-quality experience for your patients and staff. (1) All of the above adds up to our “high reliability” and where we all want to be.
Although we would like to think that our centers are low-risk workplaces, they really are not. Think of all of the possible encounters that your staff has with patients – from pre-admission telephone contact, to day-of-admission verifications, and completion of numerous forms allowing payment and care. Are you sure that your patients understand what they are presented with. Do they just sign without reading? Can they even read what you present to them? Were the instructions they received clear?
But even before your staff meets the patient, is your patient parking area safe and secure? Are there potential fall hazards on the way in to your center? Once your clinical staff brings the patient back for care, an entirely different set of encounters begins; all of which create potential for errors, no matter where the patient may be in the continuum of care. Communication – between staff and doctors’ offices, between staff and patient, between one area and another within the center – is essential. Observation and intervention are key parts of the safety culture. If your staff observes a process that could have been done differently – preferably better – they should automatically initiate discussion about this. If the process is something that can be corrected, then it should be done; and a report should be initiated whether or not there was actually a problem or the potential for a problem was noted. No one should be blamed but everyone should be educated. Every member of your staff must be involved, and management must be willing to accept ideas, comments and criticisms.
The “workers in the trenches” encounter unusual circumstances almost every day which, if they do not report, may lead to adverse events. The traditional risk management programs are based on adverse events. Investigation, often including root cause analysis, often leads to assigning blame – even before looking at the processes to see if changes could have prevented the adverse event. “Never events” and other similar activities should not strike fear into the individuals involved but should empower them to come up with ways to prevent them in the future without fear of retribution. (1,2)
So what do you need to do to enhance the culture of safety within your organization? You do need to commit resources – not necessarily direct financial resources – but certainly assign staff to coordinate your activities and educate other members of your staff.
You can look at risk management as risk prevention and coordinate with your safety program. Checklists are a useful tool in monitoring safety, but by themselves will not contribute to the “culture of safety.” Looking at trends from your safety inspections can contribute, especially if they lead to greater staff awareness of some activities in need of improvement. When staff gets involved at all levels they promote safety, and the “culture of safety” evolves to the point where it is not something you have to consciously think about every day. But it is always in the back of your minds. When you reach that point, you truly have a “culture of safety” within your organization.
1 – AHRQ PS Net – ww.psnet.ahrq.gov/ primer.aspx?primerID=5
2 – The Online Journal of Issues in Nursing: http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/No3-Sept-2011/Teachingand-Safety.html
About the author
Dr. Jack Egnatinsky is an anesthesiologist with extensive experience in the ambulatory surgery arena, both HOPD and ASC. Since starting medical school in 1961, he has been involved with many local and national professional societies and organizations and is a Past President of the Board of FASA, a predecessor to the ASC Association, and Past President of AAAHC. He remains extremely active as a Medical Director for AAAHC, in addition to being a welltravelled AAAHC accreditation surveyor, both in the USA and internationally.