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Culture eats Process for lunch Describe culture Collective mindset norms Drift Normalization of deviance What are the five elements of an ideal safety culture Reporting, inform, Just, flexible, learning James reasons book Managing the Risk of organizational accidents, 1997 Culture is it driven locally or at the organizational level Sexton at all believe that culture is more variable among units within the same hospital then among hospitals What are principles and science of patient safety 1. Standardization and checklists, 2. human factors, 3. teamwork training How do you raise awareness about patient safety Through engagement in education such as engaging the team and patient safety initiatives on error reporting near misses and disclosure an apology How do you respond to patient safety survey results Identify and disseminate best practices from high-performing units Concerns for responding to patient safety survey data Response rate reliability of data What are surrogates of patient safety culture assessment Number one, voluntary reporting of near misses, number two must be accompanied by just culture regarding how reports are dealt with in number three patient safety is a strategic priority 3 Principles and science of patient safety One standardization, checklist, to human factors, three teamwork training Patient and family involvement and patient safety initiatives may include Patient advisory Council's, community forums What are the principles of standardization Era reduction within departments, across the organization, throughout the industry, and examples include color-coded wristbands What are the principles of patient safety 1 standardization, 2 checklists, 3 learning from errors, 4 human factors, 5 teamwork training, 5 error reporting and near misses, 7 disclosures What are the principles of checkless List of actions that should be performed optimize patient outcomes. They are based on sound theoretical basis and a history of success and patient safety. For example surgical safety checklist, handoff communication. Patient safety principal learning from errors describe Here's our opportunities to want to dig deep for a root cause, and look for common causes and determine what we do when we find them Scribd the principles of human factors The interrelationship between humans the tools and equipment in the workplace and the environment in which they work. This is different than human error What are the 6 principles of teamwork training, Or a high-performing team Team structure, leadership, communication, situation monitoring, mutual support, coordination and collaboration What is the principal: error reporting and near misses Staff education, must provide clear expectation of what and how to report and be reviewed routinely and provide the Y such as giving examples storytelling lessons learned Describe the principle of patient safety disclosure Identify what needs to be disclosed, understand barriers model disclosure and apology, patient expectations, outline the process steps for the conversation 3 Disclosure barriers Lack of culture of safety, psychological barriers, legal barriers What are the process steps for a conversation on patient disclosure 1. designate personnel roles, 2. Conversation outlines, 3. Accommodations for special communication needs, 4. Support services available to the patient family and healthcare team, 5. steps for follow-up conversation, 6. Documentation of the conversation What are elements that should be included in the conversation Outline for disclosure What happened, convenience of regret, steps already taken to prevent reoccurrence, change in patient's care plan for outlook, who will contact the family next, support services to patient and family members Describe affective versus ineffective disclosures Effective disclosures provide the family with all information needed for appropriate care decisions and cannot be measured solely on the basis of whether malpractice litigation was avoided, and ineffective disclosure does not serve the patient because important information is not communicated Lack of healthcare literacy leads to Readmissions, inability to navigate the healthcare spectrum, increase health costs, limited preventative medicine, self-reported poor health What are four balance measures for managing change Patient safety implications, proactive identification, countermeasures, post change monitoring What is psychological safety Psychological safety is a believe that one will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes Psychological safety requires Softening of authority gradients Psychological safety is critical to A learning environment that enables individuals to willingly contribute to collective work on a team Traditional punitive healthcare cultures impede the creation of psychological safety by Blaming people for hours Human error quote "The single greatest impediment to error prevention in the medical industry is that we punish people for making mistakes." Dr. Lucian Leape Professor Harvard school of public health testimony before Congress on healthcare quality improvement Institute of medicine book on building a safe healthcare system "To Err is human" , With a principal first, do no harm What are three elements about human error described in to air is human 1. Human error cannot be one eradicated because it is a part of human condition, 2. The consequences of errors can be mitigated, 3. we can reduce the risk that can lead to harm Describe accountability of errors the two categories At risk behavior and reckless behavior Describe at risk behavior and how to manage Manage at risk behaviors requires feedback, coaching Describe how to manage reckless behavior Reckless behavior requires administrative consequence What are some challenges with accountability for behavior Demanding perfection versus, "no harm,No foul. Associates cannot be expected to work without errors yet they must be held accountable for the decisions with the same consequences regardless of outcome Is it good example of a culture of accountability model Just culture Describe just culture Just culture refers to patient safety support system of shared accountability's Describe two levels of just culture Healthcare institution level in clinician and staff level In just culture of the healthcare institution level they are accountable for Safe system design in for an encouraging and supporting safe choices of clinicians with clear expectations Just culture at a clinician and staff level are accountable for The quality of their choices and understanding we're not perfect as humans but we strive to make the best choices possible What is the 2008 Book on just culture Marks, just culture training for healthcare managers 2008 Just culture quote "Don't simply punish people for their actions, but always hold them accountable for their decisions. " Define at risk behavior "Behavior choices that increases wrist where risk is not recognized or mistakenly believed to be justified." And a conscious choice to do something other than what is defined in policy, protocol, law or, excepted safety norms. What are three elements of at risk behavior Normalize deviance, work around, drift Define reckless behavior Conscious behavior choice to disregard a substantial and unjustifiable risk, however there is no intention to cause harm