In 2016 the total cost burden for patient harm in the U.S. was $146 billion. Of these adverse events, 30 to 70 percent were potentially avoidable, leaving a significant opportunity for healthcare to improve patient safety. Successful and sustainable patient safety improvement rests heavily on an organizational culture of patient safety, in which leadership supports systemwide attitudes, actions, teamwork, and technology to reduce the risk of patient harm. In an era in which healthcare IT is guiding critical decisions affecting patient safety, health leaders need a sociotechnical improvement framework that addresses culture, process, and technology.
According to a 2016 study, an improved safety culture and teamwork can help health systems reduce patient harm across entire hospital systems and multiple harm types. Based on results from the Safety Attitudes Questionnaire (SAQ), as workforce attitudes towards safety improved, all-hospital harm decreased significantly, as did serious safety events.
Organizations that don’t prioritize a safety culture risk the following adverse consequences:
This article describes the sociotechnical framework of a safety culture in which staff can openly share safety information and leverage healthcare IT to support safety goals. This structure gives health systems a roadmap to improved patient safety, better healthcare and employee outcomes, and lower costs.
The Patient Safety Network (PSNET) bases its concepts of a patient safety culture on research in industries outside of healthcare that carry out complex, hazardous work. High reliability organizations minimize adverse events despite inherent risks in the workplace. In healthcare, high reliability organizations commit to a culture of safety that observes four key features:
To establish an effective and sustainable safety culture, healthcare leaders must have strategies and tools to navigate several known cultural challenges:
As explained above, organizational culture often blocks meaningful improvement or gains in patient safety. To address the cultural challenges of improving safety culture, as well as the process and technology elements that support and sustain a culture of safety, health systems can use a sociotechnical framework. Culture includes patient- and family-centered care, leadership, teamwork, frontline staff burnout, and economic impact of culture; process includes organizational fairness, reliability, and process improvement; and technology includes healthcare IT.
Figure 1 shows how a sociotechnical approach combines culture, process, and technology. The laddered score measures the three elements and shows whether a health system is doing poorly (very low) or well (very high) with its safety culture.
A patient safety culture based on sociotechnical framework has seven key strengths:
High quantitative cultural scores at the unit level don’t reflect whether an organization is using healthcare IT safely, or that its healthcare IT systems are safe. To determine if a culture of safety exists among team members or if they have a fundamental understanding of the principles of patient safety and are practicing them, health systems need qualitative data (e.g., focus groups).
The HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) scores health systems on their EMR capabilities, but these scores may not align with clinical safety. Clinical units can score a HIMSS stage five or higher, but, according to qualitative feedback from frontline staff, can still experience safety issues. HIMSS levels, however, don’t measure patient safety and culture of safety issues.
When decision making is relegated to and centralized at healthcare IT higher management levels, frontline caregivers are less able to quickly act on safety issues they identify. With local (versus top-down) oversight, frontline clinicians can address potential harm immediately. Empowering frontline clinicians with patient-specific safety analytics allows for immediate clinical decision making to mitigate or prevent harm.
Frontline clinicians must be able to easily access and use safety analytics solutions to make timely safety-related decisions. Inefficiencies with technology not only delay addressing safety issues and increases risk, but also create stress for users, which increases the risk for workforce burnout. Organizations can make efficient patient safety solutions accessible to frontline clinicians with a secure, cloud-based software module (e.g., thePatient Safety Monitor™ Suite: Surveillance Module). The Surveillance Module helps detect, monitor, and prevent patient safety events and automates reporting to provide predictive data and all-harm identification and analysis.
With an organizational culture in which frontline staff are comfortable reporting any safety or quality concerns, health systems can more accurately measure safety issues (an essential step in reducing risk). To ensure that staff are comfortable speaking up, leadership must uphold an environment of non-negotiable mutual respect for all team members.
An IT-related safety issue in one unit of a health system may indicate risk throughout the system. For example, if a medication reconciliation form for all patients in the emergency department (ED) has an error in the underlying structure and is a potential safety risk, it would affect every patient admitted to the health system from its ED. By identifying issues in one unit that can repeat across the system (e.g., incorrect/inaccurate protocols, problems with auto-population, and inaccurate medication mapping), organizations can mitigate systemwide risk.
For health systems to fully leverage IT solutions to improve patient safety, they must perform thorough due diligence before going live with the tools. Organizations risk derailing technology and improvement goals when they launch tools before testing for even basic functionality (e.g., logging on to care modules).
By incorporating qualitative and quantitative data, a simplified sociotechnical framework of culture, process, and technology gives health systems a comprehensive guideline to measure and improve their safety culture, including how they use healthcare IT solutions. Organizations can keep safety improvement on track by using the sociotechnical framework to guide periodic reassessments of their safety work and culture.
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