Using a multi-pronged approach to fix hospital culture and improve patient safety


Culture is one of the most important parts of any organization. Culture plays an active role in determining productivity, results, how an organization is viewed and how it solves problems. Nowhere is this more true and important than in hospitals and health systems, where culture quite literally translates to a safer environment for patient care.

"Any time you conduct a root cause analysis of preventable patient injury, you find that culture in a way is the mother of all root causes," says Catherine Miller, RN, senior risk management and patient safety specialist for the Cooperative of American Physicians. "For example, culture can manifest a value of production over patient safety, or culture can make it more difficult to strike that balance."

Hospital culture is representative of the shared attitudes and beliefs of an organization's staff, Ms. Miller says. For many, it's the clearest representation of "how we do things around here."

But for organizations where culture is broken, or has gone unaddressed for some time, a divide can grow among care team members, or between frontline workers and administrators, even among different units. When staff members feel their voices aren't heard by leadership, they're less likely to speak up, or they get the sense that nothing can

be done to address their concerns when they point out problems that need solving. There are a number of ways to address these issues when they arise in hospital culture, according to Ms. Miller.

These include administering detailed surveys to find out more about workplace perception and identifying where staff feel supported and where they don't, where they lack the resources they need to do their jobs well and whether they feel comfortable and encouraged to express concerns and ideas.

"In terms of assessing culture, leaders getting out from behind their desks, getting out into the units and talking to staff is a wonderful way to connect — asking what keeps them up at night in terms of patient safety and letting them know their opinion matters," Ms. Miller says.

This type of interaction can also help reiterate and reinforce the mission statement of the hospital while demonstrating that patient safety is the No. 1 priority for leadership, even though staff may lose sight of that. When that barrier is broken down, it will often demonstrate that frontline workers are completely aware of the problems and want to be part of the solutions. Their buy-in is critical if leadership hopes for lasting, sustainable improvement, Ms. Miller says.

It can be particularly advantageous to implement rounds and interface to staff after patient satisfaction surveys and safety attitudes questionnaires are given, as this provides an opportunity to address specific concerns.

"When a hospital is faced with persistent patient safety problems that never seem to improve no matter what strategy or process is developed, it's important to look at culture," Ms. Miller says. "If you're not paying attention and it's deficient in some way, it's going to impact care, and leadership needs to take every opportunity to change that." 

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