1. Murray, Kathleen MSN, RN, CNA

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Measuring your culture of patient safety

Q My organization will soon be participating in a culture of patient safety survey. Can you provide leadership talking points as to why this survey is required?

The following are four approaches to staff talking points: 1) start with the Institute of Medicine's To Err is Human: Building a Safer Health System report; 2) discuss The Joint Commission focus on patient safety, which includes the National Patient Safety Goals (NPSGs) and the culture of safety leadership standard; 3) highlight the Magnet(R) sources of evidence (SOEs) for patient and workplace safety; and 4) discuss the importance of the culture of patient safety survey and the process, from taking the survey to action plans.

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The To Err is Human report laid the groundwork for detailing strategies to reduce preventable medical errors. A key point to share with your staff is that flawed systems and processes cause the majority of medical errors. Therefore, designing safer healthcare delivery systems that make it harder for the healthcare provider to make an error can best provide a prevention of errors environment.


The Joint Commission has specific standards and elements of performance for a culture of safety and quality, such as the hospital culture and system performance expectation standard. This standard refers to "hospitals working to develop a culture of safety and quality of patient care," which requires leaders to create a culture of safety by demonstrating their commitment to safety and quality. The primary infrastructure consists of teamwork, collaboration, and communication regarding safety concerns. The element of performance is that leaders regularly evaluate the culture of safety and quality using valid and reliable tools. Additional leadership standards include establishing structures and processes that focus on safety, with an integrated patient safety program in place.


The 2014 NPSGs include identifying patients correctly, improving staff communication, safe use of medications, safe use of medical equipment alarms, infection prevention, identifying patients at risk for suicide, and prevention of mistakes in surgery. To highlight the NPSGs regarding a culture of patient safety with your staff, utilize your department outcomes data for hand hygiene compliance, patient infections, number of medication errors, and critical test reporting.


The American Nurses Credentialing Center's 2014 Magnet Application Manual includes workplace and patient safety under the exemplary professional practice model component. The four SOEs that involve safety are as follows: workplace safety for nurses is evaluated and improved; clinical nurses are involved in the facility- or systemwide approach focused on proactive risk assessment and error management; clinical nurses are involved in the review, action planning, and evaluation of patient safety at the unit level; and clinical nurses are involved in implementing and evaluating national or international patient safety goals. The SOEs clearly support nurses' involvement in continually improving the culture of safety through outcomes data, active participation, open communication, and reporting of errors and near misses so that organizations can potentially prevent future errors.


Lastly, you'll need to discuss with your staff the steps involved in the culture of patient safety survey. The first step is to let your staff know that the survey is anonymous and utilized to assess employees' perception of the patient safety culture at your hospital. I can't stress enough how important it is to emphasize to staff members that their participation in answering the survey is truly anonymous. They may ask you questions regarding the demographic data required and if they could potentially be identified. Inform your staff that if an outside vendor manages the survey, the organization only receives an organizational roll-up for the demographic data. Usually, if an area has a low response rate, that unit would potentially be rolled into another unit. After the organization receives the survey results, you'll receive instructions on how to communicate the results to your staff. The results are normally reported in strength and improvement opportunities categories.


Developing action plans with your staff based on the results is the final component of the culture of patient safety survey. Include as many of your staff members from all shifts as possible in action plan development so that they understand the results and are engaged in assisting the organization in determining how to improve the work environment to enhance patient safety.