Kerry Bommarito, M'P'H'

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Techniques for institutionalizing a safety culture

• Kerry Bommarito, M.P.H.
• June 7 , 2005

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Safety Culture

• Few phrases occur more frequently in discussions
  about hazardous technologies than safety culture.
  Few things are so sought after and yet so little
  understood.
• - Reason, 1997

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What is Safety Culture?

• The shared beliefs and values of staff working
  in an organization that determine the commitment
  to and quality of an organizations health and
  safety management
• OR
• The way we do things around here

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What is Safety Culture?

• Concept of safety culture originated in the
  nuclear industry as a result of Chernobyl
  accident
• Organizations culture can have a significant
  impact on the occurrence, reporting and
  addressing of errors and mistakes

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Components of a Safety Culture

• Financial investment in safe practice
• Open communication about safety issues encouraged
• Commitment to safety articulated at highest level
• Safety perceived to be highest priority
• Incentives aligned to promote safe practice
• Unsafe acts rare
• Commitment to org. learning rather than blame

To Err is Human. IOM, 2000
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Why is Safety Culture So Important??

• Research in other industries has found strong
  links between safety culture and significant
  accidents and mistakes, and has also linked it to
  an organizations ability to report and learn
  from such errors

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WUSM/BJC HealthCare AHRQ Study

• Vicky Fraser, MD PI
• Clay Dunagan, MD Co-PI
• Tom Burroughs, PhD
• Jane Garbutt, MD
• Kerry Bommarito, MPH
• Supported by AHRQ HS1189801
• Improving Patient Safety Health Systems
  Reporting, Analysis, and Safety Improvement
  Research Demonstrations

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Survey Development

• Focus groups and interviews with nurses, patient
  care technicians, pharmacists, clinical managers
• 33 questions from the Stanford Patient Safety
  Climate Inventory survey
• Survey assessed

• Perceptions about how information about errors
  is used
• Perceptions about personal consequences of
  reporting errors
• Perceptions about the safety programs in the
  facilities

• Safety culture
• Current knowledge about causes and frequencies of
  errors
• Behavior and attitudes toward reporting

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Study Site

• BJC HealthCare is a large nonprofit delivery
  system in the Midwest comprised of 12 acute care
  hospitals, 7 long term care facilities, and a
  home health company
• Serve rural, urban and suburban communities in
  Missouri and Illinois
• Facilities range in size from lt100 to gt600 beds
  and include 1 adult and 1 pediatric academic, 6
  community, and 4 rural hospitals

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Study Population

• Current employees of all care delivery units at
  BJC HealthCare who provide direct patient care
• Clinical manager, RN, LPN, nursing techs,
  pharmacists, pharmacy techs, surgical techs,
  EMT/paramedics, radiology and nuclear med
  technologists and technicians
• At the 4 rural hospitals 100 employees, at the
  remaining larger facilities 50 employees were
  surveyed
• 5047 eligible employees

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Survey Administration

• Questionnaires were mailed to employees homes
  using a four-wave approach over an eight-month
  period beginning October 2002
• Initial scannable survey mailed
• Reminder postcard mailed
• Second paper survey mailed to non-responders
• Third paper survey mailed to non-responders at
  facilities with less than a sixty percent
  participation rate

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Response Rate

• 51.8 (2617 of 5047) eligible employees responded

• 91 of Clinical managers
• 58 of RNs
• 42 of LPNs
• 33 of Nursing Techs

• 69 of Pharmacists
• 51 of Pharmacy Techs
• 35 of EMT/Paramedics

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Conclusions

• Culture can vary by unit, job level
• Culture should first be measured so culture
  change interventions can be tailored to different
  units, department, and groups of staff
• Remember Culture change takes time!
• Ideally, culture should be measured again after
  intervention has been implemented

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Questions????
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Contact Information

• Kerry Bommarito
• kbommarito_at_wustl.edu
• Washington University School of Medicine
• 660 S. Euclid Avenue
• Box 8051
• St. Louis, MO 63110
• 314-454-8221