For hospital management and boards
Hospital management’s role in patient safety culture. What are the benefits of using measurement of patient safety culture to improve the care you provide.
Leadership is key
Commitment to patient safety culture by leadership and management is crucial. While events leading to patient harm happen at the operational level, organisational factors play a vital role and are greatly influenced by management and leadership.
Senior leaders drive cultural change by demonstrating their own commitment to patient safety, setting examples through the decisions they make, providing the resources to achieve results and leveraging incentives and disincentives.
The importance of leadership cannot be understated. If you have a CEO that says it is important that we listen to patients and care about their experience; that we set up our staff for success not for failure. When you have a CEO that is open to listening to staff about what they need to provide the best care and to patients about how they received care. That’s when the culture is really good. Staff feel supported and patients are feel listened to.
Hospital executive interview, 2019
Why measure?
While many healthcare leaders have a deep understanding of the culture of their organisation, hospitals are complex systems and there are often differences in perceptions of culture between management and hospital staff. Leaders tend to have more positive perceptions of patient safety culture than frontline staff, and the bigger this mismatch, the more errors are made at the operational level.
With the right tools healthcare leaders can facilitate improvements in patient safety culture. Systematic measurement of patient safety culture supports leaders to better understand patterns of individual and organisational behaviour, as well as the underlying beliefs and values relating to patient safety in their organisation.
Crucially, measurement is not only beneficial to detect situations where things go wrong, but also to observe the settings where safe care is delivered consistently. Recognising the environment and conditions conducive to good patient safety is pivotal of a proactive approach to healthcare improvement.
Culture and the National Safety and Quality Health Service (NSQHS) Standards
Action 1.1 of the NSQHS Standards states that the governing body:
- Provides leadership to develop a culture of safety and quality improvement, and satisfies itself that this culture exists within the organisation
- Provides leadership to ensure partnering with patients, carers and consumers
- Sets priorities and strategic directions for safe and high-quality clinical care, and ensures that these are communicated effectively to the workforce and the community
- Endorses the organisation’s clinical governance framework
- Ensures that roles and responsibilities are clearly defined for the governing body, management, clinicians and the workforce
- Monitors the action taken as a result of analyses of clinical incidents
- Reviews reports and monitors the organisation’s progress on safety and quality performance.
Patient safety culture is everyone's business, however, the ultimate responsibility for the culture of the organisation rests with the CEO and the governing body. The importance of patient safety culture is embedded in the NSQHS Standards and the National Model Clinical Governance Framework. These documents set out the role of governing bodies in creating a culture of safety.
Patient safety culture forms one component of a comprehensive measurement and improvement system; it should be measured alongside other indicators of safety and quality, such as, complications acquired while in hospital, accreditation outcomes, mortality, patient-reported measures and serious in-hospital incidents.