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Other Safety Subcultures

Other Safety Subcultures

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Author: Capella Healthcare
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Other Safety Subcultures

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Developing Effective Teams

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Tutorial

what's covered
In this lesson, you will learn about other safety subcultures. Specifically, this lesson will cover:
  1. Reporting Culture
  2. Informed Culture
  3. Learning Culture
  4. Flexible Culture

1. Reporting Culture

The
The "Incident Iceburg"
Quezada (July 18, 2016) Introduction to “Just Culture.” ATS Incident Analysis Workshop. FAA Air Traffic Organization.

The Incident Iceberg illustrates major incidents that are readily visible, such as a wrong site surgery. However, the part of the iceberg under the water is where most of the risk lies unseen, unless people readily report minor incidents and near-incidents (misses). These risks are the early warning alarms of a potential disaster. Like an unseen iceberg that can sink a ship, they can lead to incidents if people don’t have the means to identify and course-correct before impact. The risk reporting system collects data on these minor events or near misses. This data is analyzed and disseminated to workers to support system improvement. In a safety culture, reporting is not only encouraged but is expected.

In the previous section, we set the stage for developing a culture in which people feel safe reporting potential problems. To understand where risk lies, we need a human-system interface in which people can report their inconsequential errors or near misses since they have the potential to cause injury. However, people do not readily report their missteps, especially if they believe it will result in disciplinary action. One study looked at barriers to voluntary reporting systems (VRS) and found the most common issue was the lack of trust between middle management and labor about policies, specifically about the other group’s commitment to following policies. The study found this lack of trust had the greatest impact on the success or failure of the VRS.

As previously mentioned, establishing trust is the first step toward building a reporting culture. Organizations must have the necessary skills and resources to collect and analyze safety information and disseminate it to frontline staff to help them improve performance. Management must be able to learn from the data and be willing to act on it as warranted.

To build trust, you should
  • Provide timely investigation and follow-up
  • Involve frontline staff in system improvement
  • Reward and recognize reporting
  • Engage in leader rounding to identify safety issues and provide timely follow-up and feedback
  • Consistently use Just Culture algorithm to review events
  • Determine the ideal way to provide feedback about issues
  • File:10728-Screen Shot 2020-09-30 at 11.42.54 AM.png

    Several event reporting systems are available to electronically report events and near misses. Such a report needs to be accompanied by a Reporting Policy and appropriate training on the system.

    big idea
    Here are some desired elements of a reporting system:
    • Easy way to access the reporting system
    • Confidentiality, with qualified indemnity (See Just Culture)
    • Separation of those who review the event from those responsible for administering sanctions
    • Rapid, useful, and intelligible feedback to the reporter
    • User-friendly reports that are easy to complete with free-text and discrete fields
    • Section for managers to provide follow-up investigation information
    • Creation of tracking and trending reports
    The first three elements of the reporting system address the concerns of disciplinary action for reporting. Organizations usually have an Event Reporting Policy that addresses this issue. A just culture again is key by ensuring that people understand how events will be evaluated and where to draw the line between acceptable and unacceptable actions. Evidence suggests that when a just culture is in place about 10% of unsafe acts fall into the unacceptable category. This suggests that 90% of unsafe acts are largely blameless, caused by system failures, and could be reported without fear of sanction.

    term to know

    Reporting Culture
    A culture where people have the necessary skills and resources to collect, analyze, and disseminate safety information to frontline staff and assist them with performance improvement

    2. Informed Culture

    In an informed culture, those who manage and operate the system have current knowledge about the human, technical, organizational, and environmental factors that determine the safety of the system as a whole. Data is collected, analyzed, and timely disseminated to those who need it.

    term to know

    Informed Culture
    A culture in which people who manage and operate the system have current knowledge about the human, technical, organizational, and environmental factors that determine the safety of the system as a whole

    3. Learning Culture

    A learning culture means the organization is able to learn from its mistakes and improve its systems and processes. It must be willing and able to discern the right conclusion from its safety-information system and have the drive to implement major reforms.

    term to know

    Learning Culture
    A culture in which the organization is able to learn from its mistakes and improve its systems and processes

    4. Flexible Culture

    A flexible culture is an organization that is able to effectively adapt to changing demands. For example, in the Coronavirus crisis, outpatient clinics rapidly implemented Telehealth technology to continue treating patients virtually and limit the spread of the disease. Additionally, they quickly mobilized teams to create a Drive-Thru process for COVID testing with minimal risk to employees.

    term to know

    Flexible Culture
    A culture in which an organization is able to effectively adapt to changing demands
    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
    Flexible Culture

    A culture in which an organization is able to effectively adapt to changing demands

    Informed Culture

    A culture in which people who manage and operate the system have current knowledge about the human, technical, organizational, and environmental factors that determine the safety of the system as a whole

    Learning Culture

    A culture in which the organization is able to learn from its mistakes and improve its systems and processes

    Reporting Culture

    A culture where people have the necessary skills and resources to collect, analyze, and disseminate safety information to frontline staff and assist them with performance improvement.