Miscellaneous
Reverence
Justice
Commitment to Those Experiencing Poverty
Stewardship
Safety
Integrity
What are our Core Values?
Learning
Just Culture
Reporting
What is shaping a Safety Culture?
Phase 1: Build the Foundation
Phase 2: Create the Culture
Phase 3: Care Excellence
What is the Care Excellence Transformation?
Fear
Uncertainty
Futility
Powerlessness
What gets in the way of speaking up and reporting?
StandOut Pulse Survey
What is one way we measure our Safety Culture?
Guided by our Core Values
Hold ourselves/each other accountable to safe behaviors
Share errors openly to learn and find solutions
Stand up with those who speak up
Respond to system failures/individual behaviors in a fair, just and accountable manner
Appreciate constructive feedback to protect our patients and colleagues
What is TogetherSafe?
Human Behavior
Reckless Behavior
At-Risk Behavior
What are the Three Human Behaviors?
A belief that one will not be punished of humiliated for speaking up with ideas, questions, concerns or mistakes, and that the team is safe for interpersonal risk-taking.
What is the #1 Requirement of a Safe Culture?
Power Distance in Health Care
Look-Alike
Workaround
What are some barriers?
Near miss reporting rate (current rate vs future state)
Good Catch Submissions
Huddle engagement with safety front and center (Safety issues escalated and resolved)
What are other measures of Safety Culture?
Any event or condition that could have resulted or did result in harm and was preventable.
What is a Safety Event?
Fast-paced, high risk work environment
Underreported safety events
High rate of harm compared to similarly complex industries
Workforce burnout and turnover
Why is building a strong safety culture so important?
Your voice is heard - all contributions are valued
Healthy conflict is encouraged
Failure = learning opportunity
Giving and receiving feedback
Everyone's accountable
Open to new ways of doing things
What IS Psychological Safety?
Reduce the power distance between individuals and groups
What is the Safety Culture Goal?
Stop
Act
Think
Review
What is STAR?
Report and Learn
Debrief Openly
Post incident learnings are shared (organization)
Continuously improve - striving for "failure free"
What does a "learning culture" look like?
Just being nice. Agreeableness
Freedom from conflict
Fear of making mistakes - blaming culture
Oversharing
Permission to slack off
Reluctance to try new methods
What is NOT Psychological Safety?
Layers of Defense - Safety barrier
Holes (Failures) - Inherent flaws
Alignment of Holes - Creating a clear path for hazard to reach target
Risk Stacking - Showing independent failures, when stacked, compound risks, turning unfortunate events into catastrophic ones
What is the Swiss Cheese Effect?
TogetherSafe Behavior of Quarter
What should Safety Champions post on their departments Huddle Board?
Incidents and Adverse Events
Near Misses - Also called Good Catches
Unsafe Conditions
What to Report?
Culture Psychological Safety
Improving Teamwork
Achieving High Reliability Outcomes
What is Creating Psychological Safety?