The path to zero harm: How to create a culture of safety in the OR

While errors are unavoidable, achieving zero harm in perioperative settings isn't.

In a Oct. 20 webinar hosted by Becker's Hospital Review and sponsored by Stryker, industry leaders discussed the leadership values and management tools necessary to transform ORs into high-reliability systems.

The presenters were:

  • Jessica Perlo, director of joy in work at Boston-based Institute for Healthcare Improvement
  • Valerie Marsh, DNP, RN, clinical assistant professor at Ann Arbor-based University of Michigan School of Nursing
  • Colleen Clancy Harrington, change management consultant at Hingham, Mass.-based C2 Consulting
  • Frank Federico, vice president and senior patient safety expert at the Institute for Healthcare Improvement

It's unavoidable — humans will make errors, Mr. Federico began. Of top 10 sentinel events, 30 percent occur in surgical or invasive procedures, according to the July 2020 Joint Commission report. To develop a highly reliable organization, trust must be established as a foundation of both the learning system and culture. 


Workforce harm must be considered when embarking on the journey to becoming a zero-harm organization, according to Ms. Perlo. Institutional leadership needs to be held accountable for staff well-being. Leaders should also empower the care team to speak up about unsafe, highly stressful or morally challenging conditions and ensure those concerns are addressed. High rates of burnout can stem from insufficient resources, unsustainable hours, documentation burden, racism and sexism. To address these deeper concerns, organizations must constantly ask for feedback, provide channels for anonymous concerns and articulate leader accountability, Ms. Perlo explained. 

Dr. Marsh agreed, adding that zero-harm organizations must first identify the cause of the errors. Problems are most often rooted in human error, according to Dr. Marsh, and systems have to be "brave enough to look at human factors, and then develop a just culture, which is where you don't blame people but instead hold them accountable." Cultures of blame are not found in highly reliable organizations, Dr. Marsh concluded.

Best Practices 

Culture eats strategy for lunch, as the adage goes. As healthcare leaders look to create and maintain cultures of high reliability in the OR, they must consider organizational culture as much as any other strategy deployed, including relationship-centered communication skills training (ex: Marshall Rosenberg's nonviolent communication training), structured communication rounds (ex: visual management boards) and Listen-Act-Develop models, according to Ms. Perlo.

How staff treat each other drastically changes culture, Ms. Harrington explained. One outpatient surgery center took the "Ritz Carlton approach," where patients and other departments were all considered customers. "Before walking away from one another, we'd say 'Is there anything else I can do for you? I have time,'" Ms. Harrington said, adding that the approach made people feel comfortable opening up and asking for help. The new culture improved staff atmosphere and civility, which also positively affected patient care. 

Empowering staff 

To encourage staff to champion changes that support high reliability and safety, leadership must ensure staff have the resources to effectively further the cause. "Prioritize giving that person room to explore the task they're championing," Ms. Harrington explained, emphasizing the importance of mentorship. "Mentorship is a huge piece of the puzzle," Dr. Marsh agreed. Her institution developed a program to support champions, in which nurse executives come forward with patient safety ideas and partner with someone who can help with research, provide resources, and support the nurse executives to implement and drive change.

Using technology to support safety

Change management processes often include technology that supports workforce and patient safety. Stryker focuses on developing simple solutions that support systemic changes to drive standardization and help mitigate common risks and hazards in the OR, including the Neptune Waste Management System, SurgiCount Safety-Sponge System and comprehensive smoke evacuation portfolio.

To learn more about Stryker and the journey to zero harm, click here. To view the full webinar, click here.

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