February 29, 2012 | | Comments 0
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Ask your staff: How can we earn your trust?

Every time I explore a quality improvement initiative with a hospital for Patient Safety Monitor Journal, I always ask two questions:

  • What was your biggest challenge?
  • What advice would you give to other hospitals?

Especially as of late, the answers revolve around just culture. Quality directors, nurse managers, patient safety professionals, CNOs all tell me the biggest challenge is staff trust and buy-in; the key to success is involving them in the process. We all know the key to improving is knowing what’s wrong, but unless there’s trust between the organization and the staff, you won’t find out that information.

The most recent AHRQ Culture of Safety survey – Hospital Survey on Patient Safety Culture: 2012 User Comparative Database Reportleads me to believe perhaps the knowledge of how to improve culture and safety is there, but it’s not yet in practice to the fullest extent.

This is a big survey, including data from more than a half million healthcare staff from more than 1,000 hospitals, and deserves a good look:

Teamwork within a unit was strong; 80% of respondents agreed or strongly agreed to that sentiment. Generally, staff felt that management supported them and a culture of safety, and that the organization was including systems meant to support staff and reduce errors. To me this says that the talk is there: Staff members are aware that managers and leadership care about safety, and those systems should support them, not hinder them. Seventy-five percent say that management’s actions show dedication to patient safety; 72% believe the systems are in place to prevent mistakes.

Yet when it comes to reporting or speaking up, staff are still wary. Only 62% felt there was communication openness in their organization, and the lowest scoring domain was nonpunitive response to error, with only 44% positive response to questions related to the subject.

When it gets more specific – and more personal–the rates drop lower. Most interestingly is the difference between these two questions:

  • Staff will freely speak up if they see something that may negatively affect patient care: 75% agree/strongly agree
  • Staff feel free to question the decisions or actions of those with more authority: 47% agree/strongly agree

To whom staff must speak their concerns seems to be a critical indicator as to whether they actually will. This is certainly an issue with culture. The vast majority of respondents (76%) had direct patient involvement, and 35% were nurses. Considering disparate levels of authority create the team responsible patient care, I find this low response to that particular question quite concerning.

Also noteworthy: exactly half believed mistakes are held against them. It’s no wonder the survey indicates vast under-reporting of adverse events, a claim supported by the recent report by the inspector general of the Department of Health and Human Services.

I think the next step for hospitals is to find out what it will take for staff to trust hospitals. What will it take to get a nurse to report an adverse event he or she was involved in? Or demand a time out be performed to a surgeon?

Such a large shift in thinking might take time, as we all know in decades past healthcare has been notoriously punitive. Still, perhaps we should start by asking our staff what it will take to earn their trust. After all, involving them has been the key to so many other instances of quality improvement success.

First published on Patient Safety Monitor Blog

Entry Information

Filed Under: LeadershipStaff motivation

About the Author: Katrina Gravel is an editor for the Education division of HCPro.

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