Implementing Change to achieve a Culture of Patient Safety in Healthcare - Literature review Example

Implementing Change to achieve a Culture of Patient Safety in Healthcare Patient Safety Stavrianopoulos (2016) defines patient safety as prevention of harm to patients. According to Ulrich & Kear (2014), patient safety is the foundation of delivery of health care because patient safety ensures errors are prevented; lessons are learnt from errors that occur and there is a culture of safety that entails healthcare providers, institutions and patients as well. The culture of patient safety of patient safety has direct link to behaviours of healthcare providers for example reporting of errors. Accordingly, Halligan & Zecevic (2011) suggest that it is important to implement a culture of patient safety in an organisation. Patient safety culture refers to the shared values among organisational members, their beliefs and interactions which generate organisational norms that promote safety (Verbakel et al, 2014). Patient Safety Culture Safety culture has three key constituents that include; learning culture, just culture and reporting culture. Chassin & Loeb (2013) explain that a just culture consists of a trustful culture where justice and responsibility are critical constituents. Ulrich & Kear (2014) further asserts that a reporting culture promotes reporting of errors and safety matters and therefore a learning culture promotes learning from errors as well as other safety issues. It is therefore important to ensure that a safety culture is implemented in order to ensure delivery of safe healthcare. However, El-Jardali et al (2011) argues that a safety culture that that entirely ensures reliability has trust, reporting and improvement as the key characteristics. When healthcare providers demonstrate trust in their colleagues and leadership, they are able to habitually identify and report errors as well as unsafe circumstances. Actions from leaders are what result to the trust. As Halligan & Zecevic (2011) puts it, trust occurs within an organisation when intimidating actions and behaviours that restrain reporting are eliminated and concerns of staff members are handled promptly and improvements are communicated to the involved staff members. Maintaining a culture of trust obliges institutions to hold staff members responsible to adhere to the set safety procedures and guidelines (El-Jardali et al, 2011). Ring & Fairchild (2013) emphasises that it is necessary to have clear, fair and transparent process that identify and separate blameless errors from unsafe actions that are blameworthy. When an organisation implements trust, reporting and improvement in their culture, a culture of safety is successfully reinforced. On the other hand, Halligan & Zecevic (2011) provides that subcultures of patient safety include: leadership, teamwork, evidence-based care, communication, learning, just, in addition to patient centred-care. This implies that for an organisation to ensure there is patient safety there are some subcultures that should be cultivated within an organisation. Evidence indicates that organisations that attain high reliability by successfully reducing serious hazards have “safety culture” as their foundation for promoting exceptional performance (Chassin & Loeb, 2013). However, in spite of the evident significance of safety culture in ensuring patient safety and performance improvement, a high number of health care institutions are still struggling to attain patient safety. According to Halligan & Zecevic (2011), the lack of safety culture is still the main contributing factor to many safety incidents and issues that healthcare organisations encounter. This is because as Ulrich & Kear (2014) suggests a strong safety culture ensures that risks are identified and reduced and also that patient harm is prevented. Evidence further indicates that a poor safety culture in most cases leads to cover up of errors and hence it is not possible to prevent harm or learn from the errors. Verbakel et al (2014) opines that it is important to have culture that provides opportunities to enhance and improve the healthcare system and therefore prevent patient harm; the safety culture should ensure that individuals are not blamed for errors also errors are not handled as individual failures. Changing Culture of Patient Safety Ring & Fairchild (2013) carried out a study and established that changing a patient safety culture starts at the highest organisational level and transformational leadership style has been deemed to be the most effective strategy to implement strategies to achieve a culture of patient safety. This is because as Sammer (2011) provides, transformational leadership results to creation of safety culture, implementation of patient safety strategies and finally improved patient safety outcomes. A culture of safety starts with leadership. This is because it is very hard to identify the specific element s of that renders a healthcare organisation safe. According to Ring & Fairchild (2013) leaders plays a big role in designing, nurturing and developing a culture of safety. This is line with Lykens et al (2011) who identified leadership as a critical subculture in fostering culture of safety. According to Sammer (2011) engaged leaders and management are important in ensuring a healthcare organisation fosters a culture of safety. This is because as Sammer (2011) explains, engaged leadership drives organisational culture be devising initiatives and developing structures that guide safety procedures and outcomes. This is supported by Ring & Fairchild (2013) who identified organizational leadership as being among the most important facilitators for creating and promotion of a culture of safety within an organisation. Verbakel et al (2014) also explains that building a culture of safety must start with the organisation CEO. For example, when leadership within a healthcare organisation provides transformation leadership the staff members are likely to adopt the targeted behaviour change (culture of safety). In addition, when leaders provide fair, just and compassionate leadership the followers are likely to be more willing to change and not fear reporting errors and near misses when they occur (Sammer, 2011). This is because compassionate and an understanding leadership ensures makes staff members not to fear of being blamed in case an error occurs during delivery of health care. According to Lykens et al (2011), the biggest challenge to improve quality and safety healthcare lies in changing behaviours of healthcare providers and operation systems to ensure better patient safety. Changing the patient safety culture can be a challenge, take time and slow to attain. Therefore, in order to facilitate change and attain a culture of safety within healthcare system, hospital governance and top management should put efforts in implementing safety culture within their organisations. Verbakel et al (2014) suggest that top leadership for example the hospital board should own patient safety and focus on safety and quality. Studies indicate that there are adverse patient outcomes when hospital board do not prioritize safety. This is supported by Weaver et al (2013) who argue that hospital governance and top management should implement a proactive and all-inclusive strategy to address the culture of safety. Healthcare leadership should reinforce its dedication to implementing culture of safety by being actively involved in championing and supporting process improvement by giving time and removing obstacles as well as providing the required resources to implement change in regard to culture of safety. Verbakel et al (2014) is of the view that healthcare leadership should show their support and dedication to implementing change in culture of safety through provision of clearly defined goals, supporting staff members as they work through improvement strategies, outcome measurements and communication of progress in achieving the established culture safety change goals (Lykens et al, 2011). There are numerous forms of leaders within healthcare institutions and in order to ensure there is effective change of culture of safety, support, commitment and action is required from all leadership levels (Ulrich & Kear, 2014). The hospital board, senior management, doctors, pharmacists, nurse directors and unit leaders play significant roles in ensuring culture of patient safety is implemented within a healthcare organisation (Halligan & Zecevic, 2011). This means that when implementing a culture of patient safety it is important to engage leaders at all levels and staff members in specific behaviours that support provision of safe healthcare. According to Chassin & Loeb (2013) change management is an important aspect when sustaining improvements such as change in culture of safety. Stavrianopoulos (2016) explains that there four components that should be taken into account when implementing a change in improving a culture of patient safety. The first aspect should entail planning the project by evaluating the culture of change, defining the change, developing an initiative, engaging all stakeholders and painting a vision that supports patient safety. Ulrich & Kear (2014) add that it is important to inspire all the organisational members to adopt culture of patient safety. Therefore, it would be necessary to solicit support and actively involve all stakeholders within a healthcare organisation in the plan to improve the safety culture. According to Sammer (2011), identifying a leadership group along with front-line team members within a healthcare organisation is critical for the culture of patient safety strategy. Any resistance to culture change by healthcare providers such as nurses should be addressed by developing strategies to combat any resistance (Weaver et al, 2013). It is also important to ensure that all organisation operations, recommended behaviours are aligned with patient safety. Initiatives that support change in culture of safety should be launched and the change champions and leaders influence healthcare providers to adopt a culture of patient safety (Ulrich & Kear, 2014). Change champions have the ability to influence behaviours through actively campaigning for behaviours that ensure patient safety and also role modelling behaviours that support patient safety. Sammer (2011) emphasises that change should be supported where the leadership in healthcare organisations should be actively involved in safety culture improvement. Of equal importance is ensuring that healthcare providers are recognised and rewarded in order to effectively facilitate and support patient safety culture (Stavrianopoulos, 2016). Weaver et al (2013) also supports this and explains that there should also be regular communication on positive culture of patient safety and measurable improvements reported to further motivate healthcare providers to adopt behaviours that ensure patient safety. Stavrianopoulos (2016) also stresses that it is important to recognise healthcare providers who effectively practice patient safety and promote a culture of patient safety in the workplace. References Chassin MR & Loeb JM. (2013). High Reliability Health Care: Getting There From Here. The Milbank Quarterly. 91(3):459-490. El-Jardali F, Dimassi H, Jamal D, Jaafar M, Hemadeh N. (2011). Predictors and outcomes of patient safety culture in hospitals. BMC Health Serv Res. 24(11), pp: -30-45. Halligan M & Zecevic A. (2011). Safety culture in healthcare: a review of concepts, dimensions, measures and progress. BMJ Qual Saf . 20 (1), pp:338-343  Lykens K., Singh KP, Mains DA, Lackan NA. (2011). What is Patient Safety Culture? A Review of the Literature. Journal of Nursing Scholarship. 42 (2): 156–165. Ring L & Fairchild R. (2013). Leadership and Patient Safety: A Review of the Literature. Journal of Nursing Regulation. 4(1), pp: 52-56. Sammer, C. (2011). Culture of Safety in Hospitals: A Three-Part Analysis of Safety Culture, Evidence-Based Practice Guidelines, and Patient Outcomes. Fort Worth, Texas: University of North Texas Health Science Centre. Stavrianopoulos T. (2016).The development of patient safety culture. Health Science Journal. 10(5). Pp: 1-15. Ulrich, B., & Kear, T. (2014). Patient safety and patient safety culture: Foundations of excellent health care delivery. Nephrology Nursing Journal. 41(5), 447-456, 505. Verbakel N, Langelaan M, Theo J, MD, Wagner C &. Zwart D. (2014). Improving Patient Safety Culture in Primary Care: A Systematic Review. Patient Safety. 1(00), pp: 1-7. Weaver S, Lubomksi L, Wilson R & Martinez K. (2013). Promoting a Culture of Safety as a Patient Safety Strategy: A Systematic Review. Ann Intern Med. 158(5), pp:369-374.  Read More