Putting your finger on safety culture issues in the workplace: The evidence-based, structured approach
5 December 2023
It can be hard to identify issues affecting team culture, let alone know where to start to fix it.
Activities that support a safety culture have been shown to improve staff self-compassion and personal wellbeing (Beach, Roter, Korthuis et al. 2013 ). Some of these activities are easy to implement – simple things individuals can do today. Here, the Hornsby Hospital Adult Mental Health Unit (AMHU) shares their safety culture story.
Improving the Hornsby Adult Mental Health Unit safety culture
"Staff had anecdotally raised issues with me about poor communication in our team culture and the impact on care. On working with the unit, I found it was hard to put my finger on exactly what we needed to try to fix it." Melanie Perry was the Hornsby Mental Health Quality and Risk Manager. She is now the Consumer and Patient Experience Coordinator at the Northern Sydney Local Health District Governance Unit.
Consumers always ask – when is my doctor going to see me? The ward rounds aren’t structured, I don’t know when the doctor will come. This is frustrating for the consumer and for me.
Melanie and the AMHU clinical team collaborated with the Clinical Excellence Commission Team Stripes Lead Mary Ryan to understand and address the problems in the Unit in terms of safety culture.
"The Clinical Excellence Commission has tools to help get a big picture view of interconnected safety culture issues and provided us with a structured approach to improving safety culture," Melanie said.
"There are also lots of concrete activities, called Safety Fundamentals, to roll out that can help with specific culture issues.
"I think it is important to remember that it doesn’t always need to be a huge quality project to improve things. There are simple actions you can take that can really help quickly and easily," she said.
It doesn’t need to be a huge project. There are simple actions you can take that can really help quickly and easily.
"Team Stripes gave us a structured approach to understand the big picture and to identify, prioritise and implement actions to address issues.
Although there is an estimated date of discharge documented, we had challenges with current consumer care plans. This is frustrating because, as a staff member, I can’t quickly work out what the consumer’s care plan is and what I should be doing to help them to reach their goals.
"We made a few changes to the way the team worked. For example, we revamped our Multidisciplinary Team meetings which are now much more structured. We also improved the documentation by utilising the Electronic Medical Record and the Electronic Patient Journey Boards to their full potential.
"We saw a reduction in serious incidents in the ward and a reduction in recommendations which were related to communication. Staff also felt they were more active participants in consumers’ care.
"With the support of the NSLHD Mental Health Drug and Alcohol Directorate and the Hornsby Mental Health Service Executive, we have been able to really look at how we could do things better. We made some real gains that have been sustained over years thanks to the Team Stripes structured approach to improving safety culture.
"The team realises this is an ongoing improvement journey. The team is always refining processes and the Clinical Nurse Consultant Hayley Packer continues to lead the team through this transformation process," she said.
Team Stripes quality project team at the Hornsby Adult Mental Health Unit.
Defining safety culture and the Safety Culture Framework
The culture of an organisation is ‘the way we do things around here’. It is values, attitudes, perceptions and beliefs, and how everyone behaves towards each other.
A safety culture is one where people feel ‘psychologically safe’ and feel empowered to speak out without judgement to identify and address safety issues together. It is a culture based on compassion on all levels, led by a compassionate leadership.
The Safety Culture Framework defines a healthcare safety culture more precisely, listing seven key elements for a strong safety culture. This framework is valuable when assessing the safety culture of a team or organisation, when strengths and gaps are identified.
Safety culture improvement – a structured approach
Sometimes it’s hard to know where to start to improve a team’s safety culture. There are often so many interconnecting issues, it’s hard to see the bigger picture and know what to do.
Team Stripes is a structured approach to improving safety culture. The approach starts with a discovery phase using team reflection and data to give an overview of a how a team works and its safety culture. It identifies potential areas of improvement and how they may be interconnected. It then uses improvement science to identify and implement potential solutions. This is an ongoing process of improvement, continuously strengthening a team’s safety culture.
A library of culture improvement actions
There are lots of concrete actions a person or a team can take to improve safety culture. These are called Safety Fundamentals. Some are easy and quick to do and can make a real difference.
The person-centred communication safety fundamentals are all about how we communicate to improve patient care. A change can be as simple as saying 'Hello, my name is ..' when talking with a patient.
A change can be as simple as saying ‘Hello, my name is..’ when talking with a patient.
The Safety Fundamentals for teams are practical tools, most of which can be implemented quickly and easily, and have the potential to bring quick measurable gains.
An example is the safety huddle. This is a short meeting with the whole team at the start of every shift. The team exchanges information about potential or existing safety risks for patients and staff.