Title: Safe Workplace
1Safe Workplace
- Adelaide Maria Ansah Ofei
- (MPhil, MBA, BA, SRM, SRN)
2Outline of Presentation
- Introduction
- Definition of terms
- What nurses do
- Why health care errors occur
- Active and Latent failures
- Reaction to errors
- Threats to patient safety
- Ensuring workplace safety
- Conclusion
3Introduction
- An organizations workers and their work
environment have a reciprocal relationship, each
influencing the other in an ongoing, dynamic
interplay that affects the level of safety within
the organization (Cooper, 2000). - To construct a nursing work environment that
maximizes patient safety, - the characteristics of the nursing workforce,
- the settings in which they provide care, and
- the nature of their work,
- as well as the implications of these elements for
patient safety, need to be considered.
4Definition of Terms
- According to the Oxford Advanced Learners
dictionary - Safe is defined as
- protected from danger and harm secure
- Not or unlikely to be damaged, hurt or loss, etc.
- Not likely to cause or lead to damage.
- Work is defined as
- use of bodily or mental power in order to do or
make something - Place is defined as
- particular area or position in space occupied by
something - From the above safe workplace is the
environment of professionals or workforce that
protects clients or consumers from injury or
danger in the course of providing quality service.
5What Nurses Do
- The work of nursing staff includes both visible
and invisible activities. - The visible activities are those physical actions
observable by patients and others and often
portrayed in the media, such as assisting a
patient to walk, administering medications and
treatments, and educating patients about their
disease and therapies. - The invisible or cognitive work incorporates
knowledge learned from formal education and
subsequently acquired expertise.
6What Nurses Do
- The specific activities performed by a particular
nurse depend on - Patient(s) needs,
- the nurses education and expertise,
- the setting of care in which the nurse practices,
- how nursing care services are organized and
delivered within that setting of care, and - the nurses licensure status and scope of
permitted practice as delineated in state
licensure laws. - Nursing Assistants versus Registered Nurse
7Why Health Care Errors Occur
- According to Reason (2000) there are two very
different views - Individuals are primarily responsible for any
error or unsafe action. - Unsafe acts arise principally from an
individuals faulty mental processes or
weaknesses of character, such as forgetfulness,
inattention, poor motivation, carelessness,
negligence, and recklessness. - Bad outcomes are viewed largely as the result of
bad behaviour by people, behaviour that should be
corrected through workplace policies and
procedures, safety campaigns, disciplinary
measures, the threat of litigation, retraining,
and naming, blaming, and shaming. - When workplace errors occur, the person most
directly involved in the work at the time the
error is thought to have taken place might well
be blamed.
8Why Health Care Errors Occur
- Errors typically result from problems within the
system in which people work and typically
originate in multiple areas within and external
to an organization. - Error results when these multiple problems
converge and impair an organizations
performance. - When an error occurs, the question should not be
Who is at fault? but rather Why did our
defenses fail?. - Human beings contribute to the commission of
errors in two ways through the commission of
active failures and the creation of latent
conditions.
9Active Failures
- Active failures occur at the level of the
front-line worker (e.g. nurses, physicians, and
pharmacists). - Such failures are sometimes called the sharp
end of an error. - Types of errors committed by front-line workers
include lapses in memory, misreading or
misinterpretation of written data, incorrect
performance of a routine activity as a result of
a distraction or interruption, or simply human
variations in fine motor skills. - The consequences of these actions are experienced
almost immediately.
10Latent Conditions.
- Latent conditions are factors in the production
process or system that are not under the direct
control of front-line workers. - They include poor design of work or equipment,
inadequate training, gaps in supervision,
insufficient supply of equipment to perform work,
undetected manufacturing defects or faulty
maintenance, inadequate personnel deployment, and
poorly structured operations. - They arise from strategic and other top-level
decisions made by entities at the blunt end of
an organization or production system, such as
government regulators, manufacturers, system
designers, and high-level managers and decision
makers.
11Latent Conditions.
- Latent conditions pose the greatest risk to
safety in complex or high-technology systems
because of their capacity to result in multiple
types of active failures. - Their impact spreads throughout an organization,
creating error-producing factors within
individual workplaces. - Efforts to discover and fix latent system
conditions are more likely to result in safer
systems than attempts to minimize active errors
at the point at which they occur. - Protecting patients from errors and adverse
events therefore requires an examination of
health care delivery systems to identify defects
and create stronger system-level defences.
12Reaction to Errors
- Response to error, tend to focus on retraining,
discipline (reprimanding, firing, or suing), or
other responses aimed at specific individuals. - Punitive response may be appropriate in cases of
wilful wrongdoing, but evidence has shown it is
not an effective way to prevent subsequent
errors. - Focusing only on the sharp end allows latent
conditions to remain undetected in the system,
and their accumulation makes the system more
prone to additional accidents and errors in the
future. - Efforts to discover and fix latent system
conditions are more likely to result in safer
systems than attempts to only minimize active
errors at the point at which they occur. - Nurses are the largest component of the health
care workforce, and are also strongly involved in
the commission, detection, and prevention of
errors and adverse events, our work environment
are critical elements of stronger patient safety
defenses.
13Threats to patient safety
- Patient safety is threatened by
- Inadequate staffing levels,
- Long work hours,
- Poor education and training,
- Unsafe work practices,
- Rapid increases in new knowledge and technology
- Increased interruptions and demands on nurses
time - Documentation and paper work
- Diversity of tasks and tools
- Vulnerability of the consumers of production
- Underutilization of information technology, and
- A variety of other work conditions.
14Basic Components of Organizations and
Corresponding Patient Safety Defenses
15Ensuring a safe workplace
- adopting transformational leadership and
evidence-based management practices, - maximizing the capability of the workforce,
- designing work and workspace to defend against
errors, and - creating and sustaining cultures of safety.
16Transformational Leadership and Evidence-Based
Management
- Creating work environments for nurses that are
most conducive to patient safety will require
fundamental changes throughout many health care
organizations - Work design and
- Personnel deployment, and
- Culture of the organization must understand and
act on the science of safety.
17Five Essential Management Practices
- Balancing the tension between efficiency and
reliability - Creating and sustaining trust
- Actively managing the process of change
- Involving workers in work design and work flow
decision making - Creating a learning organization
18Learning organization
- A learning organization is an organization
skilled at creating, acquiring, and transferring
knowledge, and at modifying its behavior to
reflect new knowledge and insight (Garvin,
1993). - Learning organizations do not passively wait for
knowledge to present itself, but actively manage
the learning process by taking advantage of all
sources of knowledge, using systematic
experimentation to generate new knowledge
internally, and transferring knowledge quickly
and efficiently throughout the organization. - These processes are used to create better work
tools, processes, systems, and structures in
order to improve the organizations production
processes.
192. Maximizing the Capability of the Workforce
- Promote safe staffing levels
- Support knowledge and skill acquisition and
clinical decision making - Benchmark Training Practices
- Use preceptors for novice nurses.
- Provide ongoing educational support and resources
to nursing staff. - Provide training in new technology.
- Provide decision support at the point of care.
- Foster interdisciplinary collaboration
- Provide formal education and training in
interdisciplinary collaboration for all health
care providers.
20Characteristics of Collaboration
- Shared understanding of goals and roles
- Shared decision making
- Conflict management
- Building and Nurturing Collaboration
- Leadership modelling of collaborative behaviours
- Commitment of resources to build nurse expertise
- Design of work and workspace to facilitate
collaboration - Interdisciplinary practice mechanisms
- Training
- Human resource policies
21Work and Workspace Design to Prevent and Mitigate
Errors
- The largest, best-trained, and most dedicated
workforce will still make errors its fallibility
is an immutable part of human nature. - This innate fallibility can be compounded when
the practices, procedures, tools, techniques, and
devices used by workers are unreliable, complex,
and themselves unsafehaving been designed,
selected, and maintained by other fallible
humans. - Poor designs set up the workforce to fail,
regardless of how hard they try. Safer health
care requires redesigned health care processes.
22Design of Work Processes and Workspaces
- Inherent Risks to Patient Safety in Nursing Work
Processes - Medication Administration
- Hand washing
- Reduced Patient Safety Due to Inefficient Nurse
Work Processes - Documentation and Paperwork
- Nurses spend much time documenting patient care
activities. - Multiple sources of demands for documentation and
paperwork. - Effect of the Physical Design of Workspace on
Efficiency and Safety - Design of Patient Care Units
- Patient Transfers
- Poor Communication Technology
- Sensory Interference
23Reducing Workload and Increasing Patient Safety
Through Work and Workspace Design
- What aspects of the physical environment can be
sources of error or promote safety? - What in the physical environment ensures safe
behaviour or allows room for unsafe behaviour? - What in the organization prevents or allows
exposure to hazard, and what promotes or hinders
patient safety? - What allows for assuming safe or unsafe behaviour
by the individual? - Work design needs to consider all these elements,
because of their interrelatedness. Whenever one
work element changes, there will be implications
for the other elements - Nurses work processes and workspaces need to be
designed to make them more efficient, less
conducive to the commission of errors, and more
amenable to detecting and remedying errors when
they occur.
24 Creating and Sustaining a Culture of Safety
- Employing a nursing workforce strong in numbers
and capabilities and designing the work of
nursing to prevent errors are critical patient
safety defenses. - Regardless of how strong and how well designed
such measures may be, however, they will not by
themselves fully safeguard patients. - The largest and most capable workforce is still
fallible, and the best-designed work processes
are still designed by fallible individuals. - Each introduction of new health care technology
brings a host of unanticipated opportunities for
errors. - An organizational commitment to vigilance for
potential errors and the detection, analysis, and
redressing of errors when they occur is crucial. - A high priority on safety is employed all
employees are fully engaged in the process of
detecting high-risk situations before an error
occurs.
25Essential Elements of an Effective Safety Culture
- Cultures of safety result from the effective
interplay of three organizational elements - environmental structures and processes within the
organization, - 2. the attitudes and perceptions of workers, and
- 3. the safety-related behaviours of individuals
(Cooper, 2000).
26Essential Elements of an Effective Safety Culture
- Commitment of leadership to safety
- All employees empowered and engaged in ongoing
vigilance - Organizational learning from errors and near
misses - Confidential error reporting and fair and just
responses to reported errors - Reporting near misses as well as errors
- Data analysis and feedback
- Overall features of an effective error-reporting
system
27Need for a Long-term Commitment to Create a
Culture of Safety
- Requires changes in attitudes, beliefs, and
behaviours. - It is not easily accomplished. Some have
estimated that it can take 5 years to develop a
culture of safety that permeates the entire
organization (Manasse et al., 2002). - Their development occurs in three stages
- Stage 1Safety management is based on rules and
regulations. - Stage 2Good safety performance becomes an
organizational goal. - Stage 3Safety performance is seen as dynamic and
continuously improving.
28Nursing Culture That Fosters Unrealistic
Expectations of Clinical Perfection
- Nurses are trained to believe that clinical
perfection is an attainable goal and that good
nurses do not make errors. - Requiring high standards of performance for
nurses is both appropriate and desirable, but
becomes counterproductive when it creates an
expectation of perfection. - Because they regard clinical perfection as a
professional goal, nurses feel shame when they
make an error, which in turn creates pressure to
hide or cover up errors. - It is difficult to transform thinking associated
with the blame and shame mentality.
29Need to Measure Progress in Creating Cultures of
Safety
- Objective measurement and feedback is needed to
manage planned change successfully, and efforts
to create cultures of safety are no exception. - To this end, initial baseline assessment of each
organizations safety culture and ongoing
measurement of its progress in achieving the
desired cultural shift are required. - Benchmarking Organizational Safety Culture
30Conclusion
- Errors will still occur even when the most
capable workforce provides care using the
best-designed work processes, because neither the
nurse nor the work process is perfect. - Defenses against human errors can be developed
and put in place only if nursing staff are not
afraid of reporting the errors and are involved
in designing even stronger defenses. - Finally, instituting all of these defense
strategies can be accomplished only by
individuals who have a vision of and command
resources for the organization as a wholethat
is, an organizations leadership and management. - The actions of these leaders are the essential
precursor to the creation of safer health care
environments. - They must be motivated by a passion to maximize
the safety of all patients served by their
institution.
31Thank You