Pioneers such as Leape recognized early that communication and culture were key to creating safer, errorfree systems.
These pioneers borrowed from other high-reliability fields such as nuclear power and commercial aviation, where the use of checklists and guided communication tools were effective in reducing lapses in team functioning, errors, and the likelihood of harm.”
Healthcare Research and Quality( AHRQ) says that a culture of safety encompasses four key principles:
● Acknowledgment of the high-risk nature of an organization’ s activities and the determination to achieve consistently safe operations
● A blame-free environment where individuals can report errors or near misses without fear of reprimand or punishment
● Encouragement of collaboration across ranks and disciplines to seek solutions to patient safety problems
● Organizational commitment of resources to address safety concerns
Braun, et al.( 2021) acknowledge that the terms‘ safety culture,’‘ safety climate,’ and‘ organizational culture’ are conceptually distinct but often used interchangeably:“ Organizational culture refers to the deeply embedded norms, values, beliefs, and assumptions shared by members of an organization. These elements evolve over time and are difficult to change. Organizational climate, by contrast, refers to the shared perceptions at a given point in time regarding organizational practices such as decision-making, advancement opportunities, and so on. These are more amenable to change. Safety climate is a subset( or microclimate) of overall organizational climate that focuses on people’ s perceptions about the extent to which the organization values safety( for workers, patients, and / or the environment).”
Evidence from quality and safety initiatives confirms that any meaningful and / or large-scale improvement in infection prevention and control( IP & C) practices and HAI rates requires multi-faceted strategies that address clinician knowledge, attitudes and behaviors as well as organizational factors. For example, the Comprehensive Unit-based Safety Program( CUSP) implementation framework includes engagement of frontline clinicians and institutional senior leadership; education in the science of safety; assessment of safety culture and infection control policies and procedures; regional consortia of stakeholders; expert coaching, consultation, and technical assistance; peer support; educational materials, tools, and webinars; data collection and feedback for performance monitoring; and patient and family engagement.
The intersection of safety culture and infection prevention is the sweet spot from which many modern IP & C programs operate. It is the confluence of numerous factors, and as Braun, et al.( 2021) confirm,“ The input of individual characteristics( both patients and staff) interacts with organizational structural factors( such as staffing, equipment) and culture of safety( impacted by leadership) which then influences the process of care( e. g., adherence to recommended IP & C processes such as contact precautions and hand hygiene). These inputs collectively affect the outcome of HAIs for both patients and staff.”
“ Safety culture and infection prevention are inseparable,” says healthcare safety expert Joanne Byron, BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, OHCC, ICDCT-CM / PCS, who is chief executive officer and board chair of the American Institute of Healthcare Compliance( AIHC). She has 35 years of clinical and executive healthcare experience in areas of compliance, coding, documentation improvement, auditing, privacy, and security.
“ If you don’ t have a good culture of safety and compliance and thoughtfulness of every interaction that you have with everything from drawing up a medication and doing it without contaminating the medication, to doing a dressing change, you’ ve got to be doing everything in a thoughtful, compliant manner. And that’ s what infection control is – it’ s everything you touch; for example, you go into a newborn nursery, you don’ t go around touching all the babies, you have to wash your hands and be extremely careful in everything you do if you are clinical person. And even if you’ re not a clinical person, say you’ re administrative and you go into a clinical area, you need to have appropriate training in regard to what you can touch and what you can’ t touch, as well as when you need to mask up and when you shouldn’ t mask up.”
In a blog she wrote for AIHC, Byron explains,“ Creating a patient safety environment includes complex interventions that involve the need for variations in individual work routines and healing processes as well as behavioral changes to be made on the part of the team or the individual for maximum acceptance from others. Patient safety is a framework of organized activities that creates cultures, processes, procedures, behaviors, technologies and environments in healthcare
If you don’ t have a good culture of safety and compliance and thoughtfulness of every interaction that you have with everything from drawing up a medication and doing it without contaminating the medication, to doing a dressing change, you’ ve got to be doing everything in a thoughtful, compliant manner.”— Joanne Byron, BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, OHCC, ICDCT-CM / PCS
that consistently and sustainably lower risks, reduce the occurrence of avoidable harm, make error less likely and reduce its impact when it does occur. Every point in the process of care-giving contains a certain degree of inherent unsafety. Clear policies, organizational leadership capacity, data to drive safety improvements, skilled healthcare professionals and effective involvement of patients and families in the care process, are all needed to ensure sustainable and significant improvements in the safety of healthcare.”
The National Institute for Occupational Safety and Health( NIOSH) says that cultivating a safety culture includes a strong commitment to worker safety, provision of and adequate access to safety and personal protective equipment, and extensive training efforts that utilize protocols requiring specific safety actions. NIOSH adds that“ A culture of safety describes a commitment to core values and principles by organizational leadership
mar-apr 2025 • www. healthcarehygienemagazine. com •
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