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Establishing a safety culture is key to saving lives

Tuesday, May 1, 2018

It’s a given that medical providers think about patient safety, but as Duke pediatric surgeon Henry Rice has discovered through his international research, many healthcare facilities fail to establish a safety culture—leading to preventable medical errors, complications and poor patient outcomes.

Building a safety culture delivers incredible impact for both patients and providers, Rice says. That’s why he’s so passionate about facilitating this work in low-resource settings, where instituting a safety culture is often either not prioritized or riddled with barriers such as cost and cultural, social and political constraints. 

But what exactly is a safety culture? It goes well beyond measures like sterilizing equipment and ensuring providers wash their hands before seeing patients. It’s an environment that encourages communication, collaboration, quality and safety. “A safety culture involves all sorts of decisions about how you organize your teams, time, authority structures and programs,” said Rice, a professor of surgery and global health. “But at its core, it’s about teaching a common language, culture and set of beliefs and providing a set of tools that will transform the care of the patients.”

Bria Johnston, a clinical research coordinator in the Department of Surgery, added, “It’s a collective mindfulness of safety and quality, from the small things to the big things, from the nurses’ decisions to administrative decisions.”

The development of safety cultures in healthcare facilities across the world has the potential to affect billions of lives. As Johnston puts it, “Safety culture spans every medical discipline and every level of healthcare from local facilities to national policy, and it touches every role within a healthcare organization.” Furthermore, even small, low-cost, easy-to-implement changes can lead to major improvements in patient outcomes and staff communication and satisfaction. 

Duke University and Duke Health have invested substantially in creating a safety culture, building teams committed to this initiative and engaging with experts in other healthcare systems to continually improve the culture. And now, a group of Duke faculty and staff—including Rice, Johnston and patient safety officer Judy Milne—are applying their expertise to encourage hospitals in low-resource settings to embrace the concept and establish their own safety cultures.

Rice says that one of the foundations of a safety culture is the recognition that errors are inevitable in healthcare and should be viewed as opportunities to learn and improve systems that may have played a role in the errors. “Errors are rarely one person’s fault,” he said. “More often than not, they result from a systems issue, or a combination of events that led to a negative outcome.” However, providers and hospital leadership in many places around the world favor a punitive approach against a single provider when errors occur. Changing this mindset, Rice says, has the potential to vastly improve healthcare delivery.

Rice has focused his efforts in Guatemala, where he’s been collaborating with local partners on various clinical, research and capacity-building initiatives since 2010. In a recent study, Rice and his colleagues measured the safety culture at a pediatric nephrology unit in Guatemala and used the data to develop targeted safety initiatives. They assessed staff views toward 13 health climate and engagement domains such as personal burnout, local leadership, teamwork and work-life balance.

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