Most frameworks involving a “culture of safety” place patients at the center of the care delivery model (Sammer & James, 2011). In view of health policy, Ostrom (2007) stated that frameworks are meant to organize inquiry through identification of elements and potential relationship, but not intended to specifically test, explain, or predict behavioral outcomes or strengths of association as theory would test. In the healthcare setting patients occupy the center prominence of our safety efforts; however, we offer that care providers play an equally important role in optimizing patient safety and caregivers hold a position of equivalent actors in such frameworks. Furthermore, extrinsic factors such as government agencies are at times excluded in these discussions and some frameworks are structurally complex making it difficult for end users to retain, remember, and apply concepts consistently in practice. Although a culture of safety is serious business (Denham, 2007a), it does not have to be implemented with a grim face. Joy and spirit of caregiving is also linked to patient safety. Joy comes from witnessing successful patient outcomes, and seeing the patient and family experiences of their healing journey (Hinz, 2011). Leape (2013) offers that joy and meaning will be created when the care providers feel valued, safe from harm, and being part of the solutions for change. How then do we approach a complex system framework, such as patient safety, with a program that is meaningful, sustainable, and consistently recognizable, if not marketable, to the bedside caregivers? We have found that correlation of thoughts plays a significant role in retention and recognition of information for our multicultural staff. Gigerenzer (2007) posited that the strength of recognition surpasses that of simple recall in humans. When recall memory is impaired, recognition memory often remains (Gigerenzer, 2007, p. 111). One way to strengthen recognition and information recall is through the use of mnemonics (Bakken & Simpson, 2011). Mnemonics encode complex information in which unfamiliar information to be learned is linked with known information, pictures, or symbols (Bakken & Simpson, 2011). Visual cues and auditory reminders enhance meaningfulness of new information and promote overall strength of association between novel learning and known or familiar patterns (Mastropieri, 1988).

1. Putting a “SMILE” 
On the Culture of Safety frame work
Presented at The Patient Safety &
Quality Congress Middle East
16-19 March 2014

2. Joint Presentation
• Krishnan Sankaranayanan MS, MBA, CPHQ
– Senior Safety Officer / Tawam Hospital
• Steven A Matarelli RN, PhD
– Chief Operating Officer / Tawam Hospital

3. Learning Objectives
• Attendees will be able to retain, remember,
and apply SMILE concepts consistently in
practice
• Attendees will find the SMILE frame work
meaningful, sustainable, and consistently
recognizable.

8. Google Search……….

12. Culture of Safety Is A Serious Business

13. Can it be done with a SMILE!!

14. SMILE as a Mnemonic

15. Use of Mnemonics

16. Popularly used  Mnemonic in
messaging

17. Mnemonics & Memory
• Correlation of thoughts plays a significant role
in retention and recognition
• Strengthen recognition and information recall
• Encodes complex information

18. Mnemonics & Memory
Recognize
Retain
Remember

19. Strong Influence
Joy and meaning will be created when the
care provider’s feels valued, safe from harm,
and being part of the solutions for change”
Caring for those (employees), who care for
the patients. Employee engagement, getting
them excited about providing good service to
patients, which reflects on patient loyalty and
good outcomes

20. SMILE- Model
S - Systems & Support
M -Morale & Motivation
I - Information & Open Communication
L - Leadership & Commitment
E - Empowerment & Engagement

21. Missing elements in the conventional
Frame Works
Health Policy Makers
Regulatory agencies
Care providers

23. SMILE Frame Work
• External Constructs
– Health Policy Decisions
– Regulators
– Healthcare Leaders
• Build on a solid foundation
– Commitment and Engagement

24. SMILE Frame Work
• Internal Constructs
– Patient
• Respect -patients treated with respect; without any
discrimination of race, color and religion
• Information- communicating clearly in an easily
understandable manner
• Care- unrestricted access to care
– Care Provider
• System- creating forced functions
• Empowerment- opportunities to speak up
• Support- principles of natural justice

25. Conclusion
• Although patients are at the center focus in
healthcare.
• Care providers hold equal prominence in the
patient safety movement
• Delivering safer care is linked to external and
internal constructs that influence and drive
the SMILE philosophy.

26. References
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29. Thank You