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Elements of a Safety Culture

Elements of a Safety Culture

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Author: Capella Healthcare
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Elements of a Safety Culture

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what's covered
In this lesson, you will learn about elements of safety culture. Specifically, this lesson will cover:
  1. Safety Culture Foundation
  2. Types of Cultures

1. Safety Culture Foundation

James Reason believes a safety culture is the product of several underlying, interdependent subcultures that build the foundation for a sustainable safety culture. The first building block to establish is a just culture in order to lay the groundwork for a reporting culture and an informed culture. The other two elements of a safety culture are a flexible culture and a learning culture.

big idea
A just culture is the cornerstone of a safety culture.

A safe workplace is necessary, especially in the complex world of healthcare. How is it possible to empower people to openly report adverse outcomes and risky events while holding people accountable in a just manner? The challenge is to determine if the event or potential event results from poor system design, human error, or reckless behavior that intentionally puts lives or organizations at risk.


2. Types of Culture

It is important to understand the three types of culture that can exist in an organization regarding reporting errors and near misses:

  1. blaming culture
  2. blame-free culture
  3. just culture
Each is distinguished by its level of accountability and its influence on safety.

2a. The Blame Game
A blaming culture is evident when people at work are reluctant to speak out, take risks, or accept responsibility for their actions or behaviors for fear of retribution, criticism, or worse. This can be detrimental in healthcare because most errors are not blameworthy, according to David Marx, but arise from human factors or systems design.

Historically, blame (and its sanctions) has become a way for managers and leaders to motivate people to comply with rules and regulations. However, swift blame can impede information flow and the ability to understand the cause of errors, often obscuring alternative solutions to organizational problems. Staff become aggrieved and disengaged, and this culture can generate counterproductive behavior that is contagious and toxic.

When leaders blame people for mistakes, this attitude can permeate the culture and lead to lower performance and increased employee turnover. Blaming makes it harder for workers to communicate with each other, trust each other, and work together. Organizations that are in the blame game create an unsafe space for members, thereby limiting creativity and reducing productivity and learning.

With the emphasis on safety in healthcare today, it is unfortunate that this culture continues to dominate the workplace and impede the advancement of a safety culture. People in a blaming workplace are not going to feel safe to speak up and report.

term to know

Blame Culture
A type of culture where people at work are reluctant to speak out, take risks, or accept responsibility for their actions or behaviors for fear of retribution, criticism, or worse
2b. Acting with Impunity
A blame-free culture is the opposite of a blaming culture, one in which people can report freely without fear of retaliation or retribution. This culture looks at errors as opportunities and learns from them. However, what happens when a person repeatedly engages in risky behavior or acts recklessly, with a knowing disregard for rules that could harm a patient or the organization? In this culture, that behavior goes unchecked and increases the risk of harm to the patient or organization; there is no accountability.

term to know

Blame-Free Culture
A type of culture where people can report freely without fear of retaliation or retribution
2c. Balancing the Scales of Justice
A just culture focuses on addressing systems issues that lead people to practice unsafe behaviors. It combines blame-free culture with accountability. Errors and unsafe acts that are unintentional will not be punished. However, people who act recklessly and take unjustifiable risk will be held accountable and will be subject to discipline.

A just culture creates a psychological safety for clinicians and staff to freely discuss errors or potential safety hazards in an effort to improve systems and processes. According to Amy Edmundson, “… psychological safety is the belief that the environment is safe for interpersonal risk taking. People feel able to speak up when needed — with relevant ideas, questions, or concerns — without being shut down in a gratuitous way. Psychological safety is present when colleagues trust and respect each other and feel able, even obligated, to be candid.” (Edmondson, How fearless organizations succeed 2018)

In healthcare it is imperative to have psychological safety to encourage people to self-report errors and situations that might put the patient or organization at risk. Safety culture cannot be sustained without psychological safety and a just culture in which to review events. It is the responsibility of Executive and C-Suite leaders to both create this atmosphere and to model the behavior in everything they do. Building trusting relationships is at the heart of safety culture.

term to know

Just Culture
A type of culture that combines blame-free culture with accountability
reflect
What type of culture exists in your organization?

Authored by Cindy Ebner, MSN, RN, CPHRM, FASHRM


Support

If you are struggling with a concept or terminology in the course, you may contact RiskManagementSupport@capella.edu for assistance.

If you are having technical issues, please contact learningcoach@sophia.org.

Terms to Know
Blame Culture

A type of culture where people at work are reluctant to speak out, take risks, or accept responsibility for their actions or behaviors for fear of retribution, criticism, or worse

Blame-Free Culture

A type of culture where people can report freely without fear of retaliation or retribution

Just Culture

A type of culture that combines blame-free culture with accountability