How Safety Culture Began: Origins, Qualities, and a Real Healthcare Case Example
- Jeanette Zocco
- 11 minutes ago
- 4 min read
How Safety Culture Began: Origins, Qualities, and a Real Healthcare Case Example is an important topic for healthcare professionals attempting to understand how organizational safety culture influences patient outcomes. There is no universally agreed-upon definition of safety culture. It has been generally described as the common values, beliefs and behavioral practices associated with workplace safety (Wolters Kluwer, 2017). Safety culture is a shared mindset among a team, unit, or organization regarding what is considered important, how things operate, and the way things are done (Fondahn et.al., 2016). It reflects a broader organizational commitment to safety, deliberately shaped through policies and procedures that support safe practices and mitigate risks (Naji et al., 2021). In healthcare, safety culture is a crucial component in preventing patient harm and enhancing patient outcomes. The following article describes the origins of safety culture, qualities, and a case example in healthcare.
How cultural failures lead to catastrophic harm
Safety and culture became linked together as a concept following the Chernobyl nuclear accident in 1986. Investigation by the International Nuclear Safety Advisory Group (INSAG) revealed that the explosion resulted from a series of failures due to a lack of safety culture, including but not limited to:
Poor communication
Lack of proper training
Production pressures
Normalized deviance for overriding safety practices
Lack of leadership commitment to safety (International Atomic Energy Agency, 1993)
Sound familiar? It should, as these same factors are often attributed to adverse events in healthcare. The INSAG report became a catalyst for other high-reliability industries, such as aviation and manufacturing, to adopt safety culture frameworks. As the patient safety movement evolved, this concept of safety culture and the lessons learned from high-reliability organizations were applied and integrated into healthcare.
Safety culture qualities
Safety culture develops slowly over time in response to past events, leadership, and the workforce's frame of mind. A positive safety culture exists when staff demonstrate safety behaviors even when leadership is not present to enforce them, such as conducting time-outs, pre-procedure briefings, or debriefings (Fondahn et al., 2016).
A culture of safety is described as having the following qualities:
Recognition of an organization’s operations as high-risk, and prioritizing development and maintenance of safe processes
Supportive of reporting errors and near misses without fear of punishment
Supportive of collaboration to understand problems and develop solutions to safety issues
Organizational commitment to providing resources for safety, such as equipment, staffing, and leadership positions focused on quality and safety (Agency for Healthcare Research and Quality, 2019)
Case Example
A hospital wishes to eliminate elective delivery before 39 weeks’ gestation. The hospital develops a formal scheduling and screening process so patients under 39 weeks can’t be scheduled for an induction or cesarean section that isn’t medically indicated. Staff are educated on the guidelines and participate in regular discussions about them. Some time later, a patient arrives for a scheduled induction at 38 weeks 6 days, due to a scheduling error. The primary nurse immediately recognizes the error and reports it to the charge nurse and resident. The issue moves up the chain of command as required, and the patient is ultimately sent home.
To prevent another incident, the hospital investigates how the scheduling error occurred, then alters procedures to fix the issue. In addition, the primary nurse and other staff who were involved are celebrated for their good catch. The healthcare team mitigated potential harm in the form of newborn complications because they were empowered to question the situation, report the error in real time, and advance it up the chain of authority. Then follow-up investigation and assessment created a stronger elective delivery scheduling system. These actions exemplify a strong culture of safety.
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Copyright by Jeanette Zocco MSN RNC-OB, C-EFM, C-ONQS
References
Agency for Healthcare Research and Quality.(2019, September). Culture of Safety. Retrieved from https://psnet.ahrq.gov/primer/culture-safety
Agency for Healthcare Research and Quality.(2019, September). High Reliability. Retrieved from https://psnet.ahrq.gov/primer/high-reliability
Aerial view of the Chernobyl Nuclear Power Plant after the 1986 accident — original photo by USFCRFC / IAEA Imagebank, via Wikimedia Commons, licensed under the Creative Commons Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0). Link to full license https://commons.wikimedia.org/wiki/File:IAEA_02790015_(5613115146)_(cropped).jpg#Licensing
Fondahn, E., Lane, M., & Vannucci, A. (2016). The Washington manual of patient safety and quality improvement. Wolters Kluwer.
International Atomic Energy Agency. (1993). The Chernobyl accident: Updating of INSAG-1 (INSAG-7). IAEA. https://www.iaea.org/publications/3786/the-chernobyl-accident-updating-of-insag-1
Naji, G. M. A., Isha, A. S. N., Mohyaldinn, M. E., Leka, S., Saleem, M. S., Rahman, S. M. N. B. S. A., & Alzoraiki, M. (2021). Impact of safety culture on safety performance; Mediating role of psychosocial hazard: An integrated modelling approach. International Journal of Environmental Research and Public Health, 18(16), 8568. https://doi.org/10.3390/ijerph18168568
Wolters Kluwer (2017). Safety Culture & Safety Climate: Knowing the Difference. Retrieved from https:// .wolterskluwer.com/en/expert-insights/safety-culture-safety-climate-knowing-the-difference