organizational culture and safety

Part I: Implementation of internal
Integration of MaPSaf in regards to
Patient Safety

Concepts of Internal
Integration
 Common Language
 Group boundaries for inclusion or exclusion
 Distributing power and status
 Developing norms of intimacy, friendship,
and love
 rewards and punishments
 explaining the unexplainable: idealogy and
religion

Levels of Patient Safety
Culture
 A- Pathological
 Waste of time to focus on patient safety issues
 B- Reactive
 Patient safety is a serious issue and action is only taken
when an incident occurs
 C- Bureaucratic
 Systems in place to manage patient safety
 D- Proactive
 Alert and attentive about patient safety issues that may
occur
 E- Generative
 Patient safety is an integrated in every action taken the
organization

Private Type A Hospital
 An institution that provides medical, surgical,
or psychiatric care and treatment for the sick
or the injured.

A B C D E
01. Common
Language
The hospital
obtains a
systematic way
of
communicating.
Contains many
polices and
procedure that
staff and
patients must
go through.
There are many
records kept.
They may have
all these forms
and policies but
they are not
always
effectively
utilized; in
regards of
patient
Org. only
communicate
s after a tragic
incident.
Org. has a
systematic
approach
communica
tion.
Org. Has a
system
approach
towards
communicati
on , and fully
reviewed
Org. has
established
equality if
communicati
on on staff
and patient
safety issues.

A
1. Common Language Although the Hospital may share a common
language , in a Pathological environment conflict
usually occurs when there are there are groups of
people that work in the same environment
assume about the other without any
communication. Therefore in a type A hospital
the Communication is very poor. The
communication travels from the top down. Staff
are unable or do not care to question the
managers and upper authority in this case the
Nurse assistants, nurses, Physician Assistants
listen to the doctors regarding the risk of a
patient and or other issues in the hospital. There
is no concern or need to question the upper
influence. Usually communication is very
negative and more interested fault and blame. In
regards to the patients, there is very little
concern in informing the patients anything only
communicate and provides the information that
much be given due to legal reasons. The
information is only given out of pressure of the
organization.

B
Common Lang. The Hospital may share a common language.
But the communication between staff and
management is very limited. It also works
similar to a top down type communication.
This may only alter during a tragic incident .
During such incidents the communication is
very impromptu and rather than
communicating with all units in the hospital to
prevent such incidents it kept within those
that are involved in the situation. In regards to
the patients the information given is that only
of what the hospital thinks is necessarily.

C
Common Lang. The hospital obtains a systematic way of
communicating. Contains many polices and
procedure that staff and patients must go
through. There are many records kept. They
may have all these forms and policies but they
are not always effectively utilized; in regards
of patient information and staff. Also, the
amount of information kept can be
overbearing and come to little use. However,
there is a formal communication met between
together agencies and the hospitals and
within the staff and management. Again, with
the records and information gathered
regarding the patient and other issues it is
never audited or checked to see how effective
the method is.

Common Language and D-
Proactive
The hospital contains a system of and records
that are co fully audited. There is
communication amongst the orgnzaization.
All staff are involved. There are many forms
to communicate and give feed back regarding
the hostipal. Information regarding the
patient and staff saftey is shared and audited.
The staff of the hospital communicate with
the patietns regarding saftey issues and
public involvment groups.

Common Language and E –
Generative
 The communication between the staff and the
pateitns regarding safety is equal. The management
and leaders of the hospital understand that open
communication is nesscary and much can be learned
from the staff that they manage. Everyone is
expeected to known about and learn each others
experiences that took palce in the hosptial to
prevent hazardous incidents nad or learn more
precautious saftey measures. Patients are key in risk
management and they are well informmed and
involved. New ideas are always encoraged. Criticism
is accepted as well. Electronic communcation is
established.

Developing Rules and A –
Pathological
 The hospital follows only the bare minimum
guidelines (mostly due to Government regulation)
this would entail polices, auditing, recording, rules,
regulations, committees and strategies to prevent
hazardous incidents. Safety management, does not
interest this level of organization. If something were
to occur it would be outside of the staff’s control and
claimed to be bad luck. Even after an incident occurs
the Management and staff do not care to improve or
discuss changes (since communication is lacking).
There is no concern for the safety of the patient and
if an incident were to take place the risks are worth
taking because the problems can use insurance
schemes to bail them out.

Developing Rules and B-
Reactive
 This type of Hospital contains rules and
regulations regarding safety issues but the
policies, rules committees etcetera are only
primarily used after an incident has occurred.
There is no strategy regarding risk management
only until after something takes place and once
the incident ahs passed then the hospital forgets
about maintaining safety precautions to prevent
similar incidents. This type of hospital is
concerned with protecting their image and the
organization and less concerned of the welfare
and safety of the patients.

Group Criteria and C –
Bureaucratic
 This type of hospital contains many systems and
rules, regulations and records that must be
followed,with lots and lots of paperwork; in regards
to saftey management. That must be completed by
staff and pateitns. Therefore, patietn and staff
safety is acknowldeged and important. However,
the overload of all the rules and paperwork become
merely formal tasks needed to be taken and rear
away from the importance of what the paperwork
and rules actually represent; safety to the staff and
pateitns. Therefore, all these polices and procedure
are audited but not strategical. Therefore in an
incident were to occur because of the complex
system a quick respone would be impossilbe.

Developing Rules and D –
Proactive
 Safety is of utmost importance in this type of
hosptital. It contains inclusion and exclusion critera
that are followed by the staff and managmetn of the
hopital. They have ste of rules, and reuguatlsona nd
contasnt audits to make sure that the to make
imorvemtsna nd increae the quality of the safety in
the hostpaial. The polices and regualtiosn
establlismed are constantly reviewdevleopmend and
revirewed by the staff. Contain committes with
regular meetings to improve the safety conditions.
Patients are also invovled in making imporovements
regarding the polices and reguaktions in the hospital
to make it safe as psossilbe.

Devleoping Rules and E –
Generative
 This type of hospital has integrated patient
safety and staff safety in all levels o the hospital.
They are committees, teams, services organized
to audit their programs and it is always patient
care focused. The staff working are alert and
know all the polices and protocols needed to be
taken at time of incident. The patients come first
in every aspect therefore their feedback is very
important and valued in the hospital by the staff
and management. This allows the hospitals to
further improve and manage safety and
constantly discuss improvements. Safety is
always their main concern.

Power and Status and Type A
- Pathological
 This hospital has extreme lack of distribution of power and
status. Those who managmetn and are head authroity of
the hospital have the most power and say in every aspect of
the organzation. They run the rule and regualtions. The
staff only work at the hospitl they have no internest nor any
power to question the authority. As for the patients they
also have very little say, their opinion does not matter. The
patient is of very little concern. There is no harmony
amoungst the staff and the managmetn. There are many
hiearchies with the organization. Many people work on
their own rather than together. But it can be described as a
group of people forced to work together under insignificant
leader.

Power and Status and B -
Reactive
 There is a unequal distribution of power in this
type of hosptial as well. The staff are put in
‘teams’ but not by choice only when an incident
has occurred. This is only done in response to
external reaction and demands. Therefore there
is a hieratchy not only outside of the team (those
that put the team together) but also within the
team itself. Again, also of the actions taken in
response to an incident to proteect the
organization as a whole. The staff and the
pateitns safety are of little interst.

Power and Status and C -
Bureaucratic
 This system also contains unequal
distribution of power and status. The
numeroys systems and polices are created by
the higher levels managmetn which must be
followed and completed by the staff. They
must go through loads of procedures. The
staff do not question them becaue they are
protocol.

Power and status and D -
Proactive
 The distribution of power and status is not a
priority or relevant. There is communication
and between the management and the staff.
There is no view of the management having
more or greater status than the staff and
patients. They all work as a team in order to
prevent hazardous incidents and to keep the
patients safe and satisfied. The team is than
evaluated by others to see how effective it is.

Power and Status and E -
Generative
 The distribution of power and status is not a
relevant. There is communication and mutual
respect between the management and the staff.
They all share the same vision have similar values
which allows them to work great together. They
also work together and are flexible. They a with
different people including the patients. Everyone
is equally valued. This includes everyone that
contributes to the hospital including technicians,
support staff etcetera. They all work as a team in
order to prevent hazardous incidents and to keep
the patients safe and satisfied.

Group Criteria and A -
Pathological
 Take limited precaution of who can and cannot work in the
hosptial and be administered in the hospital. Staff are only
seen as people who fill the postion just fulfill the quota.
There is no HR policy, and construction of staff
development. For example, they are not concerned with
the quality of the staff rather just having the quantity
needed to run the hosptial. Also, do not have realm of what
patients can and cannot be administered in the hospital.
Rather are only interserested in administering as many
patients without really giving direct concern or care for the
patient. Patietn is considered just a number and just more
money for the organization. Again as stated previously, if
an incident occurs the insuranc scheme can bail them out.

Group Criteria and B -
Reactive
 This type of hospital has inclusion and exclusion
criteria but is not followed adamantly. Unless an
accident occurs the management na will react
and hire staff and etcetera that may have
qualifications that fit the desirable criteria. But
once the distress of the incident quiets down the
administration will once again lack interest in
following the criteria of the staff. The patients
also lack inclusion and exclusion criteria. Since
they are not concerned with the ability of the
staff, the patients are also at risk. But action is
only taken in regards to the patient unless an
accident occurs.

Group Criteria and C -
Bureaucratic
 The hospital contains extensive amounts of
policies and rules regarding the inclusion and
exclusion criteria regarding the staff. They
quality of the staff is important. However, the
amounts of paperwork and guidelines that need
to be followed make the process of hiring staff a
long and extensive procedure. This is a similar
situation for patients,before they are
adminstered they must go though lots of rules
and paperwork before they are adminstered. The
complexity of the system is not in favor of the
hosptial at all. It rather slows many things down
and most of the paperwork is irrelevant.

Group Criteria and D -
Proactive
 This hospital is very concerned with the quality of staff and
the realm of apteitns they can give care to. They have
inclusion and exclusion criteria for both groups. Which, are
constantly monitered and have committees such as the HR
department that focus on finding the best staff to ensure a
great service for the their patients. Always looking to see
what criteria is effective in improiving their service. Such as
a ones with great educatin backroudn and experience
etcetra.They find it very important to be the best and
compare themselve with their competion. As for the
patients, because ehtye are focused on finding great staff
to provide saftery and imporement in their patietns lives
they make sure that before they adminster the patint they
fit the criteria and know that the patietn will be safe and
they will be able to provide the service that they need.

Group Criteria E -
Proactive
 This hospital is always focused on the quality of the staff
and the paitents. They have inclusion and exclusion criteria
that is constnatly monitered and reviewed. They observe all
aspects of the staff making sure that thye are well-rounded
indivuals. They are interseted of providing service that will
not only improve the patietns health but also offer them an
experience in which they feel comfortable and cared for.
The primary focus is that the patients feels comfortable and
at home. The hosptial is flexible to change in the inclusion
and exclusion criteria. Qulaity is iwhat is important not
quantity. They also have criteria for the patients and they
make sure that they also fit the criteria of the service they
can provide so that he patient can remain safe.

Reward and Punishment and
type A - Pathological
 The staff are looked merely as objects that fill
positions and the patients are also not a priority.
There is little interest or concern in reward or
punishment. The environment itself is very negative.
Therefore, being in such an environment is a
punishment itself. There really are no rewards or
punishments in this type of hospital. The worst
penalty for a staff would be losing their jobs and the
worst punishment for the hosptial would be closing
down. There are no rewards other htan money in
this type of hosptial. As for the patients there is lack
concern for the safety, the best reward is leaving the
hospital safe and healthy.

type B - Reactive
 The hospital is interested in rewards only
especially protecting the organization.
Therefore, they are only reactive when an
incident occurs. Those involved in the
incident have suffered. But the hospital takes
action after the incident and create rules and
punishes individuals that may have caused or
been involved . After the incident eh
prgranization is punished for their lack of
precaution.

type C - Bureaucratic
 This hospital contains many levels and procedures regarding
safety management. But because the processes are so time
consuming and long the if the staff do not follow the strict
procedures the management must take action to punish the
staff. Therefore, they may force a staff on leave if they are not
doing certain rules and regualtions. Also, if these procedures are
not followd an an inccident occurs. An outside system will punish
the hosptial for its mistakes. As, for rewards as time goes on the
level of senority is important in a buracratic system. Rewards,
may go for increasing pay, or status of seniority. All for being a
staff that follows the rules and stays in the hospital for long and
managing risk safety. As for patients they are concerned with
safety and rewards goes for keeping the patients helathy and
safe. Punishments would entail not being able to treat a pateitn
decreasing their safety and health.

Reward and Punishment and D
- Proactive
 This hospital values both the staff and the
patients. Therefore there are rewards and
punishments that have been implemeted in all
levels of the system. They analyze to see how
effective some of the reward and punishments
go on the performance of the staff and the
wellbeing of the patients and overall the safety
of the staff and patients. The punishments would
entail in terms of safety increasing risk in the
staff and patietns enviorment. Rewards would
entail seeing the satsifaction and safety of the
pateitns and staff.

Rewards and Punishments and
A – Generative
 This type of hosptial is highly concerned with every
aspect of the pateint and the staff. Their safety is on
great concern. This type of enviometn is very flexible
and has a great communication establsihed between
the patients and the staff. Therefore, there are little
set reguatlsions and rules regarding rewards and
punishments because the organization strives to
keep the staff and patients happy with the
surroundings and safe. If something were to go was
an incident to occur they have a committee set with
actiosnt aht need to be taken, to punish and or
reward the indviual. But they are always open for
changes and discussions.

Explaining the Unexplained
A
 They have little concern over the patients and
staff. It is possible that they leave things to god
rather than to work and prevent incidents from
occurring. If a patient and staff are suffering it is
due to their karma. Correction is based on
religious practice rather than improving the
organization. In terms of ideology, if it is a
capitalist based organization the employees only
work for the benefit of money. More focused on
profit rather than people.

Explaining the unexplained
type B
 This organization reacts based on the belief
system of their society to protect their image.
For example if an accident occurs and they
live in a religious society they focus on what
answers would satisfy the society and protect
their organization. But primarily they are
concerned with profit and that the reaction is
based on preserving their money.

type C
 In this organization they consist of a strict
work ethic. Which is not open to change. If an
incident were to occur it would blamed on an
external factor not related to their work.
There is still emphasis on the process of the
organization at the expense of the welfare of
the people.

type D
 This hospital is more interested in fining the
unexplained through scientific research. They
have research committees dedicated in
answering the unknown. They collaborate
with other organizations to further their
knowledge in such concerns. There is a equal
balance between employees, safety and
profit.

type E
 They approach profit not on the basis on the
money. The safety is the profit. They are
open-minded and flexible to meet the needs
of the employees and the patients. Their aim
is to improve benefit of patients and staff
rather than focus on money.

Part II: Implementation of external
adaptation of MaPSaf in regards to
Patient Safety

Concepts of External
Adaptation
 Mission and strategy
 Goals
 Means
 Measurement
 Correction

A B C D E
01. Mission
and
Strategy
No shared
concept of
mission
amongst the
workers in the
hospital
02. Goal
03.Means
04.
Measurement
05. Correction

Mission type A
 This hospital may contain a mission but there
no concern with fulfilling the mission because
the organzation itself does not share the
same desires or beliefs. There is no concern
for the staff, patients and for the quality of
the organzation itself.

Mission type b
 This organization contains a mission merely
as a way to set its image. It however only
becomes concerned in fulfilling the image
when there is threat on the organization
itself, due to an incident that may not adhere
to their mission, which should include
concern towards the safety of the staff and
patients of the hospital.

Mission type C
 The mission is very important in this type of
hospital. Safety should be entailed in their
mission. They create rules and polices that
follow the statement. However, with the
overload of procedures sometimes overall
understand and goal of the organization is
forgotten and lost.

Mission type d
 The mission is what main aspect of what the
hostial represents. They strve to fulfill the
mission. The staff and patients also share and
follow the mission. They contatly analayze
and see how effective the different levels
adhere to the mission. Safety is of huge
importance in their mission fro the staff and
pateitns.

Mission type E
 The mission is shared by the patietns and
staff. They constantly get feedback and
opinions on how to imporve and create a
mission that everyone shares. They are
flexible and willing to work with everyone to
create a friendly and risk free enviorment
there are some of the main componnets in
their mission.

Goal and Type A
Not interested in forming goals. Since the
staff and patients are not of any true concern.
They have no shared assumptions and values.
Without these components they cannot form
and achieve goals to improve the
organization.

Goal and Type B
 They have goals to achieve certain end
points. But they are not go great concern or
interest. It is only until a major component of
their mission such as safety is affected
through an incident. That they strive to
achieve their goals of keeping the enviometn
safe. Once the incidnet has been forgtten the
orgnaization goes back to a careless routine
until the next incident occurs.

Goal and type C
 They have a extensive amount of goals to
achieve. But within these goals they have
levels of procedures that must be completed
in order to achieve these goals. They again
overload the staff and patient with lots of
paperwork and such that in the end they lose
sight of what achieving the goal.

Goal and type D
 They have goals created and discussed from
feedback of the staff and pateints. They want
to make sure that they have the most
effective and plausible goals to achieve. They
compare their goals with their competion and
make sure that they can just the same if not
better.

Goal type E
 This type of hostapital is always flexilbe and
creating goals that can be achevied by the
pateitsn and staff. They main concern is to
fulfill goals that can be achieved. Also, the
staff and patietns share teh same values and
beliefs for the organization.

Means and type A
 This type of organization contains minimum
means. Because they do as a whole share the
same mission and carry out the goals to
achieve towards the mission. They only have
simple structure in regards to the means to
keep the organization to just function. They
create minimum outlines of design of tasks,
division of labor, org structure, reward and
incentive system control system info
systems.

Means type B
 This system has also the bare minium means,
such previosuly state. But they do not use
these componnets until an incident occurs
which causes they to react. In order to
preserve their image and protect their
organizatoin they follow the means.

Means type C
 This system has created an elborate system
of means. They have divided taks and division
of labor into organized structures and created
an incenttive system to control system and
information system. However, these
subgroups of means are very complex. This
procedures slow down the perfromcance of
the organization. This also creates stress and
overlaod to the patietnsand staff.

Means type D
 They have have a great system scheme of
means. All of which have been discussed by
the staff and the feedback of the paiiets. To
create as safe and smooth system for the
organization to work with. They constiously
observe the set to see how effective it is and
what kidn of improvements can be made to
become more successful.

Means type E
 This type of hospital has created a flexible
but productive system of means. A system
where everyone can work together as a team
but tasks are seperated and division of labor
is also seperated. The system runs smooth
and is very effective. The staff and pateitns
feel satisfed, comfortalbe and safe. They are
always open for changes and creating a more
efficient system.

Measuring Results type A
 Not concerned in improving their
environment. Therefore, there is no need to
measure results. Since, they believe that if
any accident were to occur it is only based on
bad luck.

Measuring Results type B
 Only intersted in measureing results and
effectivness on their organization when an
inciddent occurs. Prepares commitees
focused on tasks and measuring results on
the incident and how to stop it and maybe
prevent it. After the incident occurs the
organization becomes unintersted in
preventing incidents. Only intersted in
protecting the organization.

Measuring Results type C
 In a bureacraticc system there are many
audits made to make sure tat the systems are
working correctly. However, it is never
analysed to see how effective the system is.
Htye have many records on file and lots of
paper work regarding all the procideures but
little of the paperwork is utlized.

Measuring results type D
 In this type of organization is concerened
about the outcome and safety of the
emplyoees and patients. They have frequent
audits from outside organizations. Also,
within the hosptial they have commites
dedicated to observiving the docotrs, nurses
and other staff and their conserideratiom of
safety issues.

Measuring Results type E
 This type of hospital is consistly checking
safety in all levels of the organization. They
have complain bureau dedicated for patients
to give feedback and criticism regarding
performance of the hospital. Auditing within
the organization is a weekly routine, it is
integrated into the staffs organization policy.
Flexible to change in terms building materials
at the expense of spending money.

Corrections type A
 If anything incident occurs they do not blame
it on the organization they blame it on bad
luck. They do not work on correction. It is
more likely they prefer to be bailed out by
insurance schemes.

Correction Type B
 This type of organization only reacts to
correct when an incident takes place. Only
works on one level of the process. Or enough
to protect the organizations image. It does
not base the correction on safety more based
on money and preserving image.

Correction type C
 This type is of organization. They use
punishment base rather than solving the
incident. For example, firing a doctor to solve
the issue rather than changing the selection
process of hiring. They contain many
complicated procedures that lead to no result
in solving the issue.

Correction type D
 They are more concerned regarding broader
safety issues and do not pay attention to
smaller details. They are concerned with life
risking situations but not smaller dangers.
They have an open communication with the
staff and patients to improve ways of
evaluating and resolving safety concerns.

Correction type E
 This organization reviews minor to major
details in safety issues. They are always
prepared for the worst situation. They have
resources readily prepared for correction.
They staff and patients are knowledge on
how to approach a safety issue. They are
readily take responsible for any incident to
occur rather than devoid the problem.

Works Cited
 http://nzma.org.nz/journal/123-1314/4112/

 Done By:
Janaki Shah- Grand Valley State
University –UNITED STATES OF America
Shogi Almaayn-Sana'a University - Yemen
To: Middle East Technical
University

organizational culture and safety

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