How HR Can Promote a Culture of Safety

Patient safety starts with hospital workers feeling comfortable about expressing concerns. Here's how HR can help establish a hospital culture that promotes safety.

One patient safety advocacy organization thinks HR can be instrumental in building cultures that can help keep both patients and workers safe.  

"We talk about a culture where everyone is comfortable talking about errors, issues, or hazards that they see without fear of punishment," says Tejal Gandhi, MD, MPH, president and CEO of the National Patient Safety Foundation, headquartered in Boston. "And that the organization uses that information to learn and improve."

What Gandhi is referring to is a "just culture."The term is used to describe policies that acknowledge that mistakes happen, and which strive to ensure a lack of blame.  

Rather than pointing fingers and punishing someone when something goes wrong, a just culture emphasizes searching for the root cause of the error. "You make sure that the inquiry doesn't stop with, 'Dr. Jones should have known not to do that.'  

Instead, you look to understand, 'Why did Dr. Jones do that? What contributed to her thinking that this was the right course of action?' That's how you learn how to prevent these situations from happening again in the future," says Gandhi.

The information that would help hospital leadership understand what went wrong—or is likely to go wrong in the future— is usually not hard to find, but hospital workers can find it tough to reach across the aisle to employees in other departments.  

"Oftentimes, different departments become siloed… HR is in a unique position to break down those siloes," Gandhi says.  

She recommends three ways that HR leaders can start instituting a more collaborative culture conducive to safety.  

1.Educate Leadership
Partner With: CEO, Board of Directors

Make sure hospital leadership understands why a just culture matters. An open, fair culture where workers feel comfortable sharing concerns and information across departments leads to improved patient outcomes, says Gandhi.

Teach hospital leaders about root cause analysis and ensuring that they are committed to resolving safety issues—not just assigning blame.  

Also, leaders should be aware of the very real dangers that threaten healthcare professionals. For example, not only are nurses five to six times more likely to be assaulted than a cab driver in an urban area, but the high potential for on-the-job injury is enough to cause burnout.  

"If your workforce is getting physically or psychologically harmed, it will be hard to deliver the best care to patients or achieve patient safety," Gandhi says.  

2.Institute Executive Walkarounds
Partner With: CEO, CMO, CNO, Department Leaders  

Hospital workers cannot trust executive leadership if they don't know them. Instituting executive walkarounds can help.

As a former Director of Safety at Brigham and Women's Hospital in Boston, Gandhi remembers how she and her colleagues were able to ensure communication among departments, the C-suite, and healthcare workers.

"I would go on walkarounds with a team of executives—usually the CEO, the CNO, and the CMO." Each week, they would choose a floor or department in the hospital to visit and they would talk to people who worked in each department.

The topics discussed would vary as the workers got to know the leaders better, but the discussions would usually come back to safety—both of workers and of patients. "Initially people were nervous, but then they talked about their concerns," Gandhi says.  

So that workers knew their concerns were not falling on deaf ears, the executive team would create plans to address them on the spot, whenever possible.  

The walkarounds helped show the hospital's frontline workers that they could talk about their concerns without getting punished. The program also helped to remind the executive team what life is like in the hospital's trenches—and that the job of a healthcare worker is not easy.  

3.Establish a Physician Compact
Partner With: CMO, Physician Leaders

To clarify expectations as to workers' attitude and behavior, some healthcare organizations are asking clinicians—especially physicians—to pledge in writing that they're committed to good behavior and patient care, says Gandhi.  

Known as physician compacts, these documents sets expectations for physician behavior at the hospital, establishing the importance of respect toward other physicians, nurses, hospital leadership, frontline workers, even housekeeping staff—but, above all, patients.

"Many leaders in safety say disrespect is a cancer that will prevent you from getting to a culture of safety," says Gandhi. While a physician compact is not legally binding, it does establish that the hospital expects physicians to act in a certain way.  

But even that's not enough. "Leadership must be committed," Gandhi says.

In turn, she suggests adding a clause to compact stating that when physicians see a process they feel could be improved or which they feel is unsafe, they will not be punished for bringing attention to it.

Gandhi suggests expanding these compacts to other workers as well. They "really set expectations around behavior," she says.