Academic journal article Online Journal of Issues in Nursing

Nurses Create a Culture of Patient Safety: It Takes More Than Projects

Academic journal article Online Journal of Issues in Nursing

Nurses Create a Culture of Patient Safety: It Takes More Than Projects

Article excerpt

Abstract

Healthcare organizations are embracing the sciences of safety, improvement, human factors, and complexity to transform their culture into a culture of safety and high reliability. Nurses are the front lines of healthcare delivery, and as such, the front lines of safety and quality processes and outcomes. Nurses are required to both understand and develop the skills needed to improve care processes and to own the work of improvement as a professional responsibility. These changes demand that nurses understand both the complex demands of providing harm-free care and the system dynamics needed to create the conditions for improved outcomes, organizational, and system performance, and intraprofessional development and teamwork. The author presents the challenge of maintaining a safe patient care environment and describes a model that can detect and mitigate the migration of safe nursing care into at-risk and unsafe nursing care. She emphasizes the importance of healthcare organizations performing as high reliability organizations and outlines "planned practices' steps to introduce new technology and innovation, and concludes by considering the interaction between individual practice and system performance.

Citation: Morath, J., (September 30, 2011) "Nurses Create a Culture of Patient Safety: It Takes More Than Projects" OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 3, Manuscript 2.

DOI: 10.3912/OJIN.Voll6No03Man02

Key words: High reliability organizations (HROs), borderline tolerable conditions for use (BTCU), dynamic system model, health care safety, failure mode and effects analysis (FMEA), human factors, safety science, improvement science

Exceptional leadership in nursing is more essential than ever before. The increasing emphasis on safety and quality in care delivery demands new knowledge and skills. Today's healthcare professionals acquire and practice the skills to improve care processes, and own the work of improvement as a professional responsibility. Basic health sciences curricula now include content in the sciences of safety, improvement, human factors, and complexity. The foundation of a transparent healthcare setting, defined by Leape et al. (2009) as an environment in which defects are made visible and learnings are shared freely and without inhibition, is being recognized and embraced for the purpose of advancing safety and improvement. Organizations are creating environments characterized by psychologically safe spaces in which open communication is expected and rewarded, and errors can be examined without fear (Morath & Learv, 2004). Nursing professionals on the front lines of care and in healthcare management positions need to expand their portfolio of skills in order to provide the clinical leadership needed to achieve a culture of safety. It is important to see each nurse as a caregiver and healer, and also a system improver, prepared to improve the systems of care rather than to become a victim of a faulty and error-prone system.

The Challenge

The work of Zimmerman, a professor and researcher in organizational science and complexity, provides a helpful context for the following discussion addressing safe patient care. Glouberman and Zimmerman (2004) have identified the nature of three categories of problems: simple, complicated, and complex. The following Table summarizes the characteristics of these categories of problems.

Adapted with permission from Glouberman, S. & Zimmerman, B. (2004). Complicated and complex systems: What would successful reform look like? In Forest, P., Marchildon, G., & Mclntosh, T. (Eds.), Romanow Papers: Changing health care in Canada, Vol. 2 (p. 22). Toronto, Ontario. Copyright (Table) 2004 by Brenda Zimmerman.

Each diagnosis, individual patient, care delivery model, and social context has simple, complicated, and complex problems. Healthcare delivery is often approached as if the problems encountered are all simple or complicated problems, and many of them are. …

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