In today’s rapidly changing healthcare environment, physicians and practice administrators are taking stock of their organization’s culture to ensure it promotes patient safety. For many years, when a mistake occurred in a healthcare organization, the standard practice was to identify who was to blame and take corrective action to minimize the chance of a recurrence.
More and more, healthcare managers are making concerted efforts to cultivate a pervasive culture of patient safety. While patient safety has always been paramount to medical practitioners, the way it is achieved is changing. Creating a patient safety culture shifts the focus away from the blame game that punishes individuals for failures—which can increase liability over the long term—toward creating policies and procedures that cultivate an environment of openness and foster patient safety.
In a healthcare organization that promotes a strong, patient safety-first culture, managers make decisions based on the best outcomes for patients, and encourage employees’ efforts to advance the practice of good medicine. Employees are empowered to point out potential risks and communicate ideas for improvement. They become invested in strengthening the organization’s patient safety culture because they’ve collectively helped develop it.
While final responsibility rests with the physician leaders, in a medical practice centered on patient safety, the entire staff is vested in positive outcomes—from the appointment scheduler to the front desk receptionist to the medical assistant and beyond. Patient safety becomes everyone’s responsibility, not just the doctors’ or managers’.
With a greater focus on fostering a patient safety culture, practice leaders have developed a strong interest in benchmarking their efforts in that area. To do that, they may look to assessment tools to help. These tools can measure whether current office procedures and policies enhance a practice’s culture of patient safety or undermine it.
The Agency for Healthcare Research and Quality developed an online assessment survey that serves as a status checkup on a practice’s culture. Risk managers then compare an individual practice’s survey results with those of practices across the nation and provide specific recommendations for cultivating a culture that promotes patient safety.
"The survey set important benchmarks for where we were and the areas we need to devote our energy,’’ said Jason Miller, practice administrator for Reiter, Hill, Johnson & Nevin, an OB/GYN practice in Washington, D.C. “For a big practice like ours with three locations, it’s a good learning tool for mitigating risks and achieving goals.’’
Administered online to clinicians, support staff, and managers under strict confidentiality, the assessments cover contributing risk factors, including managers’ communication styles, management practices, policies, procedures, and daily office routines across all departments and clinical areas. Practices have been able to identify the need for changes that include staff training and communication, follow-up protocols, and medication management.
“The survey provided a great opportunity for our practice to step back and take a good look at what needs to be done to operate as safely as possible and promote a culture of patient safety across the organization,’’ said Darryl Willett, MD, group president of Ohio ENT & Allergy Physicians in Columbus, Ohio.
A culture assessment can be especially beneficial to practices that are expanding quickly or that have grown through mergers or acquisition. It helps identify gaps in training, communication, and the consistency of policies and procedures, especially among organizations spread out over multiple locations.
Dr. Willett’s practice used results to add a liaison to communicate concerns from the staff to the physicians in a constructive, non-accusatory manner. The group also assigned each doctor a “person of attachment’’ to keep close track of the doctor’s client work, and limited the physicians’ schedules to relieve pressure on supporting staff. What resulted was a more engaged staff that is eager to work collaboratively to improve the practice.
Ted Abernathy, MD, managing partner of Pediatric & Adolescent Health Partners in Midlothian, Virginia, used a culture assessment to make procedural changes to how they communicate and manage referrals. Each was designed to enhance patient safety and give the staff more confidence that their protocols and standards were working as intended.
Mr. Miller, Dr. Willett, and Dr. Abernathy invited The Doctors Company risk managers to analyze the survey results, benchmark them against other practices, and make recommendations for specific initiative and interventions that build on their practice’s strengths. It was offered without cost as part of their membership in the physician-owned organization.
“We totally trusted the results and recommendations from the risk manager, who made everyone feel comfortable,’’ Dr. Abernathy said. “It wasn’t about making accusations or pointing fingers. It was about showing us that by doing things slightly differently, we could improve our delivery of care and enhance the practice of good medicine.’’
Healthcare organizations should not only take safety culture assessments, but repeat them regularly to gauge the impact of new policies, procedures, and initiatives. Creating a patient safety culture ultimately lessens potential risks, allowing healthcare practitioners to focus on caring for patients instead of defending their practices.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.