Successful implementations of patient safety technologies like Vitalacy’s Automated Hand Hygiene Monitoring Solution rely heavily on a strong culture of safety in the healthcare organization. In my years of experience working in partnership with infection prevention leaders across the country, I have found that engaging early and often with leaders and staff leads to an easier adoption of new programs.
Challenges in Staff Engagement
Healthcare facilities have long grappled with the challenge of staff engagement in infection prevention protocols and programs. According to a 2022 study published in the International Journal for Quality in Health Care, there appears to be a positive correlation between employee engagement and patient safety. Engaged employees were more likely to report safety concerns and also to participate in efforts implemented to improve system weaknesses in order to improve patient safety (Scott, Grace, et al., 2022).
One of the key barriers to implementing a patient safety protocol or technology is the fear of punitive measures. When healthcare workers perceive monitoring behavior as a means of punishment, it can erode trust and create a culture of fear. This is where the delicate balance between monitoring and coaching becomes essential to avoid a sense of “big brother” surveillance among staff.
Methods to Keep Staff Focused on Reducing Patient Harm
Leverage data for coaching opportunities to create a non-punitive atmosphere centered on reducing patient harm. To achieve this, it is essential to ensure staff understand that the data collected to improve patient safety and experience. Data should be seen as a tool for self-improvement and team empowerment. When healthcare workers realize that data is used to identify areas for improvement and provide coaching, it fosters a sense of ownership and responsibility.
Studies have demonstrated that punitive measures are less effective in promoting safety and improving outcomes in healthcare. Here are some notable studies that support this assertion:
- Study: “The Role of Organizational Culture in Healthcare Error Reporting“
- Study: “Association of a Non-Punitive Approach to Errors and Mistakes With Resident Distress and Empathy”
These studies collectively highlight the negative effects of punitive measures on error reporting, learning, and overall patient safety. They underscore the significance of fostering a non-punitive culture that encourages open communication, learning from errors, and continuous improvement in healthcare organizations.
Healthy Safety Cultures Across the Country
A Vitalacy hospital partner in Georgia amplifies their quarterly hand hygiene performance awards program with a fun competition. Leadership has even gone the extra mile by recognizing their top performers and providing additional incentives, further enhancing overall participation. Staff members who were initially hesitant later joined their colleagues in the fun, which helped strengthen their buy-in.
A Vitalacy hospital partner in Virginia seamlessly integrated Vitalacy assets and messaging into their facility’s culture, making it seem like it is directly a part of the facility branding. This strategy was pivotal in securing initial buy-in from staff and leadership. It effectively demonstrated to the staff that leadership was committed to improvement and accountability, especially among physicians.
Shifting the perspective of patient safety technology away from simply a performance measurement towards a tool for cultural change yields a more positive reputation of the program or initiative among staff. One of our key support mechanisms for clients and infection preventionists is our quarterly performance awards program and regularly scheduled check-ins. These meetings serve as a valuable platform to address any challenges staff may be facing with the system, gather input on recommended features or enhancements, and refresh clients on the system’s functionality and the most effective ways to communicate new information.
Creating a culture of safety that utilizes data for coaching requires a multifaceted approach including a top-down open communication from many disciplines. Here are some key methods to keep staff focused on reducing patient harm while maintaining a non-punitive atmosphere:
- Training and Education: Continuous education and training programs are essential. Make sure your staff is well-informed about the importance of infection control and the consequences of lapses. Training should be interactive, engaging, and focused on practical solutions.
- Recognition and Rewards: Recognize and reward healthcare workers who consistently adhere to infection control protocols. Positive reinforcement goes a long way in fostering a culture of safety.
- Exercise Collaboration: Encourage staff to collaborate and share best practices. When healthcare workers see their colleagues as allies in the fight against infections, it reinforces the sense of a collective responsibility.
- Actionable Data and Feedback: Implement technology solutions, such as IoT-enabled Bluetooth wearables offered by companies like Vitalacy, to provide real-time feedback to healthcare workers. This data can be used to highlight positive behaviors and provide immediate coaching when deviations occur.
- Transparent Communication: Maintain open and transparent communication channels. Encourage staff to report issues and concerns without fear of retribution. Use data to identify trends and address systemic issues proactively.
Key Actions to Foster a Safety Culture
Vitalacy suggests the following actions for healthcare organizations to consider:
- Transparent and Non-Punitive Reporting: Implement a reporting system that encourages staff to report adverse events and unsafe conditions without fear of punishment, fostering a culture of learning and improvement.
- System-based Approach: Distinguish errors caused by poorly-designed systems from unsafe individual errors to drive system-level improvements.
- Model Appropriate Responses: Leaders should set an example by responding to incidents in a supportive and constructive manner, encouraging staff to report and learn from mistakes.
- Clear Communication of Policies: Establish and communicate policies that support a safety culture, including the reporting of adverse events, close calls, and unsafe conditions.
- Acknowledge and Share Lessons: Recognize and acknowledge incident reports, and share the lessons learned with the entire team, fostering a culture of shared learning and continuous improvement.
- Measure Safety Culture: Establish baseline measures to assess safety culture performance within the organization, providing a foundation for targeted improvements.
- Analyze Survey Results: Regularly analyze safety culture survey results to identify opportunities for improvement and prioritize areas that require attention.
- Unit-Based Initiatives: Encourage and empower units to take ownership of safety culture initiatives, allowing for localized improvements and fostering a sense of responsibility.
- Safety Culture Training: Integrate safety culture team training into quality improvement projects and organizational processes, ensuring that all staff members are equipped with the necessary knowledge and skills.
- Assess System Strengths and Vulnerabilities: Conduct thorough assessments to identify system strengths and vulnerabilities, allowing organizations to prioritize improvement efforts effectively.
- Regular Assessments: Repeat safety culture assessments every 18 to 24 months
Alternative methods to punitive measures in promoting safety and accountability include:
- Education and Training: Providing comprehensive education and training programs to ensure that all staff members are equipped with the necessary knowledge and skills to perform their duties safely. This can include regular training sessions, workshops, and simulations that focus on best practices and error prevention.
- Reporting and Learning Systems: Implementing non-punitive reporting systems that encourage staff to report incidents, near-misses, and unsafe conditions without fear of reprisal. These systems should emphasize learning from errors and using them as opportunities for improvement rather than assigning blame.
- Root Cause Analysis: Conducting thorough root cause analyses to understand the underlying causes of errors or adverse events. Instead of focusing solely on individual culpability, this approach seeks to identify system failures, process issues, and environmental factors that contribute to incidents. By addressing these underlying causes, organizations can implement effective preventive measures.
- Just Culture Approach: Adopting a just culture approach, which distinguishes between human errors, at-risk behaviors, and reckless behaviors. Human errors and at-risk behaviors, which are unintentional or result from system issues, should be met with support, coaching, and systems improvement. Reckless behaviors, on the other hand, require appropriate disciplinary measures.
- Feedback and Coaching: Establishing a culture of constructive feedback and coaching, where supervisors and leaders provide guidance and support to individuals involved in incidents or errors. This approach focuses on helping individuals learn from their mistakes, develop skills, and improve their performance rather than solely applying punitive actions.
- Process Improvement Initiatives: Encouraging staff to participate in process improvement initiatives and quality improvement projects. By involving frontline workers in identifying and implementing solutions, organizations can foster a sense of ownership, engagement, and empowerment, leading to safer practices and enhanced outcomes.
- Recognition and Rewards: Implementing systems to recognize and reward individuals or teams for their contributions to patient safety, such as demonstrating proactive safety behaviors or actively participating in safety initiatives. This promotes a positive safety culture and encourages continuous improvement.
- Leadership Support and Role Modeling: Leaders should actively support and champion a non-punitive approach to safety. They should communicate clear expectations, provide resources, and act as role models by openly acknowledging errors, encouraging reporting, and demonstrating a commitment to learning and improvement.
Introducing Vitalacy's Expertise
At Vitalacy, we understand the challenges that infection preventionists face in creating a culture of safety within healthcare facilities. Our IoT-enabled Bluetooth wearables and data analytics solutions are designed to empower healthcare workers with real-time data that focuses on coaching and improvement, not punishment. We believe that every member of the team plays a crucial role in reducing patient harm, and our technology is here to support and enhance those efforts. Together, we can work towards the common goal of reducing patient harm and ensuring the highest standards of infection prevention in the healthcare facility.
Scott, Grace, et al. “Exploring the Impact of Employee Engagement and Patient Safety.” International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care, U.S. National Library of Medicine, 30 Aug. 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC9384574/.
Bean, Mackenzie, and Erica Carbajal. “‘We Can’t Punish Our Way to Safer Medical Practices’: 2 Experts on Criminalization of Medical Errors.” Becker’s Hospital Review, 1 Mar. 2022, www.beckershospitalreview.com/patient-safety-outcomes/we-can-t-punish-our-way-to-safer-medical-practices-2-experts-on-criminalization-of-medical-errors.html.
Cheney, Christopher. “Avoid Punitive Approach to Your Safety Event ReportingChri.” HealthLeaders Media, 4 Sept. 2020, www.healthleadersmedia.com/clinical-care/avoid-punitive-approach-your-safety-event-reporting.
Gallagher, Thomas H. “Disclosing Unanticipated Outcomes to Patients: The Art and Practice …” Disclosing Unanticipated Outcomes to Patie The Art and Practice, Lippincott Williams & Wilkins, 22 Sept. 2022, bioethics.pitt.edu/sites/default/files/Welch%2C%20Disclosing%20Unanticipated%20Outcomes.pdf.
Machen, Samantha, et al. “The Role of Organizational and Professional Cultures in Medication Safety: A Scoping Review of the Literature.” International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care, U.S. National Library of Medicine, 31 Dec. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC7097989/.
“Safety Culture Survey Results – Patient Hand Offs and Non-Punitive Response to Errors.” Brigham and Women’s Faulkner Hospital, www.brighamandwomensfaulkner.org/about-bwfh/news/safety-culture-survey-results-patient-hand-offs-and-non-punitive-response-to-errors. Accessed 19 Sept. 2023.
Smallwood, Rebecca. “11 Actions Leaders Can Take to Develop a Safety Culture.” Relias, 3 May 2022, www.relias.com/blog/11-actions-to-develop-a-safety-culture.