Safety Culture

Understanding the difference

• Responsible: Answerable for somethings within ones power and control.
• Business Owner/Dentist with ultimate responsibility for decisions made and every action taken for those who work for you. Degree of ownership and personal investment.

Understanding the difference

• Accountable: Subject to giving an account or having the obligation to report, explain or justify something. Expectation with no power or control.
• Employee needs to respect that someone has responsibility for what they are doing.

SAFETY MINDSET

Safety Mindset

• Carries through out areas other than Infection Control like:
• Surgery, Anesthesia, Addressing medication use, Staff Competence, Fire Safety, Medical Equipment, Emergency Management, Security

Safety Mindset

• Staffing levels are sufficient and staff has necessary tools and skills · Trained properly · Supervised with authority · Continue with continuing education

Safety Mindset

• Dentist Responsibility and Commitment · Doctor is licensed to provide care, treatment, and services in a safe manner · Held responsible through licensure · Comply with recommendations from external authorized agencies - CDC, FDA, OSHA

Safety Mindset

• Not Blame Free · balance learning with accountability · Leaders need to assess errors and patterns of behavior that undermine the culture of safety · Their needs to exist a clear, equitable, and transparent process for recognizing the infallible errors that humans make and blatant unsafe reckless behaviors that warrant disciplinary actions or termination. · Lots of tools out there that have formal decision process to assist in making those determinations. Can be individual corrective action to systems level corrective action

Safety Mindset

• Their needs to exist a clear, equitable, and transparent process for recognizing the infallible errors that humans make and blatant unsafe reckless behaviors that warrant disciplinary actions or termination.

Safety Mindset

• Lots of tools out there that have formal decision process to assist in making those determinations. Can be individual corrective action to systems level corrective action

Safety Mindset

• Example: Incident Decision Tree (adapted by the United Kingdom’s National Patient Safety Agency from James Reason’s culpability matrix)

Leadership

• Creating a culture of Safety · Complies with the Law · Virtuous (morally excellent) · Commendable (worthy of high praise) · Builds a positive reputation · Commands/Fosters respect from team · Creating your TEAM mindset with you as the leader

Become a Learning Organization

• Team Learning
• when personal mastery and shared vision come together. Honest mistakes are forgiven so learning can be experienced

Become a Learning Organization

• Shared visions and goals
• the team does the tasks because they want to do so instead of they are told to. It changes the relationship with the company, and it turns its performances in a learning mechanism

Become a Learning Organization

• A shared mental model (that is, similar ways of thinking)
• communicating what the company is doing and why will help team members accept and implement changes. When they have a clear vision of where we want to go and how to develop then it is easier to adopt the new image of the company.

Become a Learning Organization

• Individual commitment to lifelong learning
• Personal mastery occurs when an individual has a clear vision of a goal, combined with an accurate perception of reality. This gap between the vision and reality drives the employee to practice all necessary related activities to realize the vision

Become a Learning Organization

• Systems Thinking
• focus on the big picture and notice that action and consequences are related to one another in interrelationships and patterns.
• Leaders determine cause and effect.

Become a Learning Organization

• In a learning organization, patient safety events are seen as opportunities for learning and improvement.
• Therefore, leaders in learning organizations adopt a transparent, nonpunitive approach to reporting so that the organization can report to learn and can collectively learn from patient safety events.

Become a Learning Organization

• In order to become a learning organization, an organization must have a fair and just safety culture, a strong reporting system, and a commitment to put that data to work by driving improvement. Each of these require the support and encouragement of organization leaders.

Helpful Tips

• Facilitating the vision
• Before sharing your vision, ask everyone else first to share their vision. Creating a vision is everyone’s job. Thus, even though you might be confident of your vision, you should also ask what the rest of team thinks of it.

Helpful Tips

• Accomplishing goals
• Focus on outcomes, and not on output. When thinking strategically, it is the result and not the process and activities that have to be executed. Do not rush in developing a strategic plan, give it time to permeate.

Helpful Tips

• Previous results
• All documents and related activities that have been performed at an early stage or project do not expire. It can provide background and lead into a direction to complete certain tasks. Use other people’s knowledge and share this with others.

Moving Forward

• Implement changes to improve performance of the office
• Describe approach to performance improvement
• Provides the resources required for performance including sufficient staff, access to information, and training
• Can describe how this supports a culture of safety and quality

Moving Forward

• Ensures team is competent to complete assigned responsibilities
• Evaluate effectiveness of those working in the office to promote safety and quality

Safety Culture with the Team

• Safety Culture with the Team · Everyones first priority · Honor code/Ethics · Aim for 100%

Safety Leader is the Dentist (you)

• Establishes priorities for performance improvement
• Follow safety guidelines put into effect and model desired behaviors
• Ask the right questions to get people to think and apply initiative to safety improvementSeek feedback on their safety leadership behaviors

Safety Leader is the Dentist (you)

• Drive focus on proactive exposure reduction and eliminate risk in real time
• Have a deep understanding of the activities their office in undertaking and demonstrate active support
• Relentlessly drive the message in all that they do

Creating the Environment

• Trust -Reporting -Improvement Cycle
• Coworkers support one another when identifying an area of improvement or a safety event

Creating the Environment

• Leaders foster trust, which enables staff to report, which enables the organization to improve - staff gets back positive feedback when improvement comes from their reporting

Creating the Environment

• Leaders need to create an environment that does not have intimidating or unprofessional behaviors. A code of conduct is something that can help define acceptable behaviors and behaviors that undermine a culture of safety

Creating the Environment

• Otherwise this can prevent collaboration, communication and teamwork which is required for safe and highly reliable patient care.
• Manifest as outburst of anger to humiliate, foul language, shaming others, unjustified negative comments, refusal to comply with generally accepted practice standards, etc.

Everyone is accountable

• for all aspects of the program. However, as we move through this think about which team members you will assign specific duties to hold them accountable.

Rewards

• Reward when performance meets or exceeds expectations - correctly immediately when it does not.
• Reward accountability must be applied fairly and equitably to everyone from senior management to hourly workers.

Not what you EXPECT it is what you INSPECT!

• Documentation is crucial
• If it isn't documented it didn't happen
• Need to have effectual procedures in place
• Provision for systematic identification, evaluation and prevention or control of hazards

Not what you EXPECT it is what you INSPECT!

• Often exceed the minimum safety requirements (such as OSHA standards) to address all hazards
• As the size and complexity of the organization increases so does the need for written guidance

EVALUATION (Current Situation)

• Create a list of what the staff tells you they are doing
• What do they say they actually do when you ask them. Write down - ok to paraphrase.
• Understand Current Procedures & Protocols

EVALUATION (Current Situation)

• Anything in writing in a binder. It usually has the words OSHA on it.
• Safety Data Sheets (SDS) Binder or Folder on desktop
• Everyone know where it is or how to access?

EVALUATION (Current Situation)

• What is the protocol for a needlestick injury?
• Are there sharps containers available?
• What kinds of PPE is provided and does it match the hazards present?

EVALUATION (Current Situation)

• Do they have a completed hazards lists?
• Are the required posters hanging up in a place the staff and can see?
• Are exits clear?

EVALUATION (Current Situation)

• Ask to see Documentation on what they are doing
• Who does them?
• Any logs?
• Where is that kept?
• Who is held accountable for them?

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