Practical ways to improve patient safety in healthcare – identifying the specific factors that have the greatest impact

Insync’s research, based on data from 16,000 clinical staff from 36 Australian health care facilities, indicates that fostering a positive hospital safety climate requires strategies and interventions at three levels:

• Organisational level – having a strong and proactive organisational commitment to safety, a positive work environment and visible managerial support
• Team level – fostering teamwork and collaboration between staff members who work together
• Individual level – promoting individual engagement and connection with the health service

To get a sense of which attitudes and practices have the most impact on patient safety, we correlated the data from 41 statements from our Safety Climate Survey against the critical statement “I would feel safe being treated here as a patient”. We believe that this statement is the acid test – based on their intimate knowledge of the health service, would clinicians entrust their own care to this service? The statements most strongly correlated with the willingness to be treated there yourself are those that should be given highest prominence. There were 11 statements with a moderate to strong correlation of over 0.45 with the critical statement. Four statements relate to the organisational level, four to the team level and three to the individual level.

This shows that all three levels are very important for building a positive safety climate. All three levels are also interrelated and therefore interventions must be targeted at all three levels to be effective.

a. Leadership and organisational context

Building a positive safety climate must start at the top. Clear direction, commitment and empowerment from leaders must be the starting point, with buy-in and commitment to cascade down the organisational tree. It is the responsibility of leaders to set the safety agenda, be clear on this direction and empower those below them to drive action.

The safety culture items from a whole of organisation perspective that are most strongly correlated with the statement “I would feel safe being treated here as a patient”, in order, are:

• This health service does a good job of training new personnel
• All the necessary information for important decisions is routinely available to me
• Leadership is driving us to be a safety-centred organisation
• Health service management supports my daily efforts

The correlation analysis show that perceptions that the health service does a good job of training new personnel is one of the most important things a hospital can do to build confidence in safety practices. If staff have confidence there are sufficient induction and training programs in place, they can feel confident that safe care is being provided to patients, and that they themselves could feel safe being treated in that health service. A clear message of safety-centred focus, a feeling of support from management and belief that all required information is routinely available to staff is also important in fostering a positive safety climate and building confidence in patient safety.

b. Department and team dynamics

An individual’s direct team is much closer to the day-to-day work experience of employees. Department and team dynamics relating to safety climate include the work area dynamics, the social environment and co-worker support. The most strongly correlated items with the critical safety item in this area are:

• Errors are handled appropriately in my work area
• I have the support I need from other personnel to care for patients
• The doctors and nurses in this health service work together as a well-coordinated team
• It is easy for personnel in my work area to ask questions when there is something they do not understand

These items highlight the importance of process management, collaboration, support and high team morale. Perception of how errors are handled in the work area is the highest correlated team item. Errors will always happen, but are they managed in a constructive way and in a way that ensures they will not happen again? Availability of assistance and support and the feeling of working and collaborating together are also important team dynamics that influence the perception of safety. Doctors, nurses and other health professionals are essential in the delivery of patient care, and therefore their ability to work together as a well-coordinated team is vital to ensuring the best outcomes for the patient.

c. Employees/individuals

Whilst individuals bring their own personality, attitudes and behaviours into the workplace, their level of engagement is also impacted by the organisation’s leadership, culture and messaging. An individual’s ability to cope under pressure and stress, their own physical and mental health and their propensity to engage with the organisation are just some of the individual factors that influence patient safety.

The items at the employee/individual level that are most strongly correlated with the critical safety item follow:

• I am proud to work at this health service
• This health service is a good place to work
• Working in this health service is like being part of a large family

The strongly correlated items relating to the individual highlight the importance of employee engagement and the extent to which they enjoy their work, feel proud of the organisation and feel they belong. The level of engagement of employees speaks to the extent to which employees will think, feel and act in a way that is positive for the organisational as a whole, with benefits stretching much further than safety alone.

To find out more about patient safety or the measurement and improvement of other health metrics, please contact our General Manager and Health practice leader Murray Chapman by email mchapman@insync.com.au or phone +613 9909 9227.