May / June 2012
Culture’s Reciprocal Rewards
Spring is a busy season for conferences. In May, I attended a few and missed a few because there weren’t enough hours and days in the month. At the ones I did attend, the effect of an institution’s culture on patient safety was a common theme. Simply put, an institution that wants to improve patient safety must treat all of its constituents—patients, families, staff members, medical professionals, executives, and board members—as respected, informed, and active members of a team. I like to think the institution will “feel the love” or, at least, respect in return for maintaining a culture that is safe and supportive for all.
At the unSummit for Bedside Barcoding (www.unsummit.com), I was reminded that establishing and sustaining that kind of culture in today’s society is not an exercise for Pollyanna. Clyde Spense, PharmD, director of pharmacy services at the Charleston Area Medical Center, gave an eye-opening presentation about medication diversion. At first, naively, I found it hard to figure how managers and clinicians can even think about establishing enough trust to allow all team members to report adverse events and close calls, to ask tough questions, tell difficult stories, and support each other in efforts to improve and celebrate their work if they are also on the lookout for co-workers stealing drugs.
The more I think about this dilemma, the more I see that culture—a “culture of patient safety” or “Just Culture”—is appropriate not only for transparency and open communication, but also for tackling drug diversion. Just Culture doesn’t guarantee honest, respectful behavior. In fact, it acknowledges that individuals may behave recklessly, make bad decisions, and fall into dangerous habits and even dishonest actions. Just Culture establishes a framework that helps team members hold each other accountable and offers a process for identifying disruptive and dangerous behavior. In this way, Just Culture provides a safer environment for everyone, not just for patients.
Soon after the unSummit, I attended a workshop put on by MITSS (Medically Induced Trauma Support Services) and co-sponsored by the Institute for Healthcare Improvement, which focused on crisis management, especially how to foster effective peer support for clinicians coping with emotional stress related to medical errors, crises involving co-workers, and other unexpected events. Toward the end of two intense days of presentations and discussion among an international, interdisciplinary group, a number of people said they look forward to the day when it is no longer necessary to develop programs for peer support because caring for each and every member of the team—in good times and in crisis—had become the foundational culture of the institution. This, too—sincere, honest peer support—is compatible with Just Culture, crucial for improving patient safety, and helpful for dealing with willful wrongdoing.
While individuals and institutions will always face unexpected challenges, tragedies, disturbances, dishonesty, and even criminal behavior, the kind of culture to which we now aspire for improving patient safety will also help protect and nurture institutions and all of their constituents and community members.