Health and Safety Culture - Essay Example

Health and Safety Culture Contents Contents 2 Executive Summary 3 Introduction 4 Works Cited 10 Executive Summary Introduction It is predicted that the changes in health care over the next ten to fifteen years will far outweigh the changes made in the last 150 years. When one ponders that statement, it makes one realize how fast the industry is moving forward and just how far it has come. Computers and the Internet are changing the way we communicate, internally and externally, professionally and personally, and how health care is delivered, managed, and paid. Advancements made through research in diagnostic and treatment methodologies are also rapidly changing the picture of health care (Grogan and Patashnik 2005). Another significant area of growth that will forever transform the health care landscape is the aging of the population. Increases in life expectancy, the ability to maintain good health, and the escalation in population growth will necessitate a different approach to health care delivery methods and payment structures. However, it is being increasingly evident what has not successfully advanced is greater satisfaction with how the healthcare is delivered, managed, and paid. Concern about the frequency with which adverse events occur continues to rise. Adverse events occur in hospitals for many reasons. Some may be unavoidable (Becher and Chassin 2001). An uncommon allergic reaction to a properly prescribed and administered medication, for example, is unfortunate but is part of the risk associated with accepting any medical intervention. Some adverse events are the result of mistakes or malfeasance on the part of individuals. It is easy for an individual clinician to misread a prescription or administer the wrong dose of a drug to a patient as a result of stress or a momentary lapse of concentration. There are few occupations where errors and accidents are more costly than in health care. The list of mistakes that each clinician accumulates is probably some complex function of length of time in clinical practice, situational factors, individual characteristics, and random chance. Stories about staff causing deliberate harm to patients are rare but memorable and form an important constituent of public discourse about risk and danger in healthcare settings (Fontanarosa, Rennie and & DeAngelis 2007). Background The journey to a culture of safety begins with the belief that health care workers go about their daily work wanting the best for their patients and do not intend to harm them. The truth is professionals are devastated by error when it occurs, and they create safety every day by anticipating, compensating for, and recovering from risk. But people are imperfect instruments and cannot create safety alone (Basky, 2000). The work of patient safety is certainly not about cautioning people to be more careful. It is about changing the medical culture and changing our personal responses to error and unintended events. The work of patient safety is about transforming and fundamentally changing how care delivery is designed, organized, and managed, and that is the leader's job (Carroll, 1997). However, a sociological perspective suggests that many adverse events that occur in hospital are due to failures of the system rather than individual failures. Many of the errors, accidents, and disasters that happen in hospitals are rooted in features of the organization. Starting from the premise that complex organizations have both the capacity to achieve goals that individuals cannot achieve and introduce new sources of error, this argues against automatically ascribing errors in organizations to the ignorance, incompetence, or immorality of individuals (Bloche, 2004). There have been efforts to move the culture of healthcare organizations away from blaming individuals towards an analysis of systemic sources of error. Although there has been a growing realization that the 'blame culture' which surrounds adverse events in hospital is destructive, there is still a tendency to locate the sources of accidents primarily in the behaviour of individual staff members rather than in the social organization of work (Bodenheimer, 1999). Milczarek and Najmiec (2004) indicate that the safety culture of an organisation indicates its climate, since the culture shapes the attitudes of the employees towards risks and safety. This indicates employees would have a respective personal aspect towards this problem that may be defined as safety culture. This can also be defined as a way of acting with focus towards life and maintenance of health. Factor analysis of empiric questionnaire in this study indicates that a lower level of safety culture leads to accidents, health problems, and dangerous situations (Milczarek and Najmiec 2004). However, the concept of safety in healthcare is not only employee safety, safety in the healthcare environment preferentially means safety of the patients treated and cared for in the hospital environment. Schutz et al. (2007) highlights that the improvement in patient safety in the healthcare organisations is a direct determinant of development of patient safety culture across healthcare organisations of all sorts (Schutz et al. 2007). Saturno et al. (2008) indicated that patient safety means minimisation of errors in care in order to reduce adverse events. Since only a sound safety culture can lead to full accomplishment of implementation of processes and systems, measurement of safety culture would be needed to design and manage activities which can improve safety. In this context, every healthcare organisation will have its customised safety culture and the strength of this culture in modifying safety and minimising risk of it would depend on the size of the organisation. Every safety climate will have its strengths and weaknesses, and the difference will be determined also by the type of health professionals, the services they provide, and obviously the size of the organization. This study revealed four important determinants of safety culture within an organisational environment. These were "Staffing", "Teamwork across hospital units", "Overall perceptions of safety" and "Hospital management support for patient safety" (Saturno et al. 2008). Moreover, positive attitudes towards safety culture were encountered more in small organisations than in larger hospitals. According to ARON (2006), building a culture of safety is a must for all healthcare organisations. This culture would foster a teamwork approach where open discussion of errors among the provides is expected to lead to improvement of process and systems without reprimand, reprisal, or fear. Truly, improvement of safety through minimisation of errors can only be achieved through learning and knowledge, and any new learning within any work environment would need flexibility. Therefore flexibility is an important component of safety culture. ARON further reiterates that the culture of safety would include open and honest communication, a work environment and system that emphasise on teamwork against individual, standards and practice built on multidisciplinary framework, interdisciplinary collaboration with helpful and supportive people, employee relationship based on trust, friendliness, and openness, open relationship that emphasises on attentiveness and credibility, a creative workmanship, resilient superiors, all seeking the best possible outcome for the patients. This would direct practice focused on work flow and process. It is not difficult to conceive that all these attributes of safety culture are supported by an informed culture with openness and flexibility to learn from near misses and incidents (ARON 2006). At all levels of the organisation, a commitment of safety must be incorporated, and this could be a top priority at the cost of any other issues, such as, efficiency. In fact in order to ensure compliance of patient safety initiatives, there must be provision for incentives and rewards to promote safety culture. The sociological perspective argues that the compartmentalization of work increases the likelihood of adverse events by introducing the need for communication and monitoring. As the number of employees in an organization grows, the number of communication channels increases at an even faster rate. Larger size and increased complexity create greater opportunities for mistakes to occur. Now organizations are not only ubiquitous in social life, they are complex in structure and generate new social roles and positions. Modern health care, scientifically and technologically sophisticated, demands the existence of complex organizations to coordinate the activities of the many individuals required to contribute their specialist expertise. The division of labour that results from increased specialization brings problems of coordination, communication and cooperation (Gottschalk, 2005). It is no longer possible for one person to hold all the specialist knowledge needed to treat patients. The members of the healthcare delivery team, who are often educated separately and may have little informal communication, may have only a limited understanding of each other's role. This is not just because of the increasing scientific and technical sophistication of medical care, but also because of increasing specialization of the occupations and professions involved in health care. The nursing profession, for example, has become increasingly specialized over time and is now recognized as encompassing a large number of groups, each of which is in possession of specialist expertise (Rothman and Rothman, 2003). Nurses who work in intensive care, psychiatry, or in the community are no longer interchangeable - a 'nurse' is no longer just a 'nurse'. At the same time, the role of the nurse in the healthcare team has become more specialized. The more specialized occupations become, the more room there is for error unless systems for coordination, communication, and cooperation are functioning well (Berman et al., 1994). Without effective financial management or profit margin, hospitals and other healthcare organizations cannot fulfill their mission of providing needed medical and healthcare services to their communities. Although healthcare organizations serve as community resources, they are also complex businesses, and like any business, their success depends on the leadership of managers and executives who understand and can apply key financial principles to fulfill their roles. Healthcare is unique in the way it is financed. It is characterized by a pluralistic system of public and private financing, and public and private delivery of services, that is unmatched in other industries. An understanding of the issues surrounding third-party payment and payment methodologies, government healthcare programs, complex receivables management, managed care requirements, corporate compliance programs, and so on requires special effort and special resources (Mechanic, 2004). There has always been a financial impact of patient safety. There have been new approaches on the financial impact of patient safety, the public's concern about accounting integrity and our industry's response to that concern, and the historic legislation designed to control healthcare costs while still ensuring that high-quality healthcare is accessible to everyone. However, increasing complexities of healthcare delivery systems have led to a situation where safe and quality healthcare is very difficult to be accessed by all, or at least by most, compounded by the soaring cost of living. Works Cited Bloche, M. G. (2004). Health care disparities - science, politics, and race. The New England Journal of Medicine, 350, 1568-1570. Bodenheimer, T. (1999). The American Health Care System-The Movement for Improved Quality in Health Care. New England Journal of Medicine 340:488-92. Carroll, R. (ed.). (1997). Risk Management Handbook for Health Care Organizations (2nd ed.). Chicago: AHA American Hospital Publishing, 1997. Fontanarosa, P. B., Rennie, D., & DeAngelis, C. D. (2007). Access to care as a component of health system reform. Journal of the American Medical Association, 297(10), 1128-1130. Grogan, C., & Patashnik, E. (2005). Medicaid at the crossroads. In: J. A. Morone & L. R. Jacobs (Eds), Healthy, wealthy and fair: Health care and the good society (pp. 267-295). New York: Oxford University Press. Milczarek, M. and Najmiec, A., (2004). The relationship between workers' safety culture and accidents, near accidents and health problem. Int J Occup Saf Ergon; 10(1): 25-33. Saturno, PJ et al. (2008).Analysis of the patient safety culture in hospitals of the Spanish National Health System. Med Clin (Barc); 131 Suppl 3: 18-25. Schutz, AL., Counte, MA., and Meurer, S., (2007). Development of a patient safety culture measurement tool for ambulatory health care settings: analysis of content validity. Health Care Manag Sci; 10(2): 139-49.. Read More