Moving toward a Culture of Safety discusses creating a culture focused on patient safety, learning from mistakes, and continuous improvement. The document emphasizes that culture impacts quality and safety, with high power distance cultures less likely to question authority and more prone to blame subordinates. It promotes developing a culture with situational awareness, situational leadership, encouraging reporting, and a focus on learning and improvement. Success requires addressing power dynamics and communication to develop a strong culture of safety.
5. “Professionals should not be afraid to make
mistakes. They should be afraid of not learning
from the ones they do make.”
Sidney Dekker, “Just Culture; Balancing Safety and Accountability”, 2007
11. Culture is what happens when we interact!
“…cultures-and the specific norms that define these
cultures-emerge as unintended byproducts of
interpersonal interaction.”
Lehman et al., Ann Rev Psych 2004;55:689-714
12. Power Distance Index
The higher the power distance in a culture, the less likely those
in subordinate roles will question the actions or directions of
individuals in authority.
“Power distance is the extent to which the less powerful
members of organizations and institutions accept and expect
that power is distributed unequally.”
13. High Power Distance Index Cultures
Those in authority openly use their rank.
Subordinates expect clear guidance from above.
Subordinates take the blame (Second Victim).
The relationship between boss and subordinate
is rarely personal.
Politics is prone to totalitarianism.
Class divisions within society are accepted.
14. A Tale from St. Elsewhere….
Very experienced OR RN
Recent stress leave due to ‘Bullying’
Circulating in Orthopedic OR
In the midst of the ‘Timeout’….
15.
16. Situational Leaders
Any team member who has the skills to manage the situation
“The principle role of a situational leader is to mobilize
and support the Situational Awareness of the team.”
17. PDI: Mitigation in Communication
•Command
•Team Obligation Statement
•Team Suggestion
•Query
•Preference
•Hint
Quality Chasm!I would submit that the journey is perilous not just for patients but for providers and innovators.It is clear that we just need to do the things we already know about but do them better and more consistently
When he couldn’t find any he took out his sword and chopped the knot in half. Now he had loose ends!!Alexander the Great went on to conquer the known world.
This is an important slide. I am looking for a loose end in the way we look at culture.What are the dynamics that govern interaction in the healthcare system?
Hostede’s cultural dimensions work now includes six dimensions.PDI has a huge impact on the nature of interactions, so influences culture pervasivelyWhat is the pattern of interaction we see when PDI is high?
How does this play out in terms of MRSA prevention?How does this play out in crisis in the middle of the night?What does communication look like here??
Communication is the bread-and-butter of social interaction.Communication can be learned and unlearned!One of the most important dynamics in terms of the quality of communication is PDI, but we can train subordinates to be more effective, and we can therefore change culture.
