O T H E R F E AT U R E S Fostering Safety-Conscious Healthcare Providers: A Leadership Initiative INTRODUCTION Lea Anne Gardner, PhD, RN Patient safety is a national priority1-3 and a fundamental part of healthcare4 that Senior Patient Safety Analyst healthcare stakeholders address through a range of activities, including government Pennsylvania Patient Safety Authority legislation,5 accreditation programs,6 quality improvement initiatives,7 and research lit- erature.8 Senior leadership is influenced by these activities while shaping and defining a healthcare facilities’ patient safety culture and work environment. Senior leadership is central to a patient safety culture that empowers healthcare workers to maximize their performance in the delivery of safe patient care.9,10 Yet patient safety is not solely the CELEBRATE PATIENT SAFETY responsibility of senior leadership; it is the responsibility of the entire healthcare facility. ATTAINMENT ORGANIZATIONAL EMPOWERMENT The Pennsylvania Patient Safety Authority periodically highlights reports Patient care delivery is an accumulation of multiple individual decisions made by of healthcare workers who take excep- healthcare workers; one wrong decision can create a situation that leads to an adverse tional action to avoid patient safety event. Although all healthcare workers set out to deliver safe patient care, the amount adverse events. There are many les- of control they have over their work plays a pivotal role in the outcome. The com- sons to be learned from the everyday mitment of organizations to a patient safety culture empowers employees to make successes of healthcare workers who decisions that result in positive patient safety actions.11,12 Healthcare workers who can do the right thing at the right time. function autonomously yet interdependently within a team are more likely to make In this issue of the Pennsylvania sound decisions about the patient care they deliver. Patient Safety Advisory, a lab tech- Employee empowerment is not a single activity or goal but an organizational attitude nician’s astute observation and and strategy, created by leadership, that values each individual’s contribution to the investigative skills, triggered by suspect lab data, identified the root organization.13,14 This organizational attitude enables teams and individuals within a cause of a potential series of incor- team to think critically and act on their own initiative, for example, to question actions rect clinical decisions and actions. or situations that threaten the achievement of organizational outcomes, such as the This one person prevented multiple delivery of safe patient care.13 An individual’s control over and responsibility for deci- patients from inadvertently receiving sion making is at the core of empowerment.13,14 It has been shown that employees who an incorrect treatment. have more discretion over their work demonstrate improved feelings of confidence in The Authority would like to hear from their work, job satisfaction, commitment, and retention.9,11,13,14 Pennsylvania facilities in which some- Developing an atmosphere of employee empowerment depends on the leader’s ability one’s actions resulted in the avoidance to trust and support his or her employees’ expertise, skills, and judgment. The leader of a patient safety adverse event. There functions as a facilitator or coach and in this role establishes a model of team work, are several ways to notify the Authority, sets shared goals, and creates an environment that enables individuals within a team including through regular reporting to make decisions so the team can arrive at a set of successful outcomes. Employee in the Authority’s Pennsylvania Patient Safety Reporting System, by notifying empowerment requires leaders to share their power and to acknowledge that employees the facility patient safety officer, or by help the organization to achieve its goals.13,15 This level of employee-leader interaction contacting a regional Authority patient should to be introduced incrementally. safety liaison. For the first six months of 2011, Pennsylvania healthcare facilities reported to the Pennsylvania Patient Safety Authority more than 8,000 near-miss events in which the actions of empowered healthcare workers prevented adverse patient events. Each reported event identifies healthcare workers whose attention to detail and ability to make decisions helped keep their patients safe. The following reported event exemplifies a patient safety action that prevented multiple patient adverse events: A technologist discovered problem with calciums [calcium results] on evening shift fol- lowing PM [preventive maintenance] on daylight shift, prompting her to rerun QC [quality check], which was out of range. Quality check following PM was acceptable. All patient specimens were sent to another lab for testing. The technologist alerted [the physician] that calcium results may be suspect. The technologist notified Urgicare [sic] that the original report was incorrect and relayed the correct results. The physician Page 114 Pennsylvania Patient Safety Advisory Vol. 8, No. 3—September 2011 ©2011 Pennsylvania Patient Safety Authority assured the technologist that no treat- development of a fair and just environ- — Follow through on promises. ment was initiated based on incorrect ment where suspect actions and decisions — On a case-by-case basis, question or results. The next morning, a review regarding the delivery of safe patient change rules that have been shown of results indicated that the reported care can be evaluated and lessons can be to be flawed. glucose was also suspect and was learned.20,22 Knowledge obtained from — When possible, allow employees to corrected. The senior technologist noti- evaluations of these actions and decisions choose their own path and structure fied staff of correct results for calcium can inform and improve employee work their work, so they can achieve good and glucose. processes, thereby improving the delivery results while getting the job done.14 Further details from the report indicate of safe patient care. — Adapt work conditions as demands that the analyzer in question was not Creating a just culture that empowers change; use an incremental used for further testing until the next employees is a process as individualized process.12-14 afternoon, after it was serviced. This tech- as leadership management styles and is — Vary levels of empowerment based nologist’s insight and actions prevented influenced by organizational culture, on job responsibilities and tasks.13,14 several patients from being treated incor- complexity of work tasks, and level of — Celebrate near misses internally with rectly based on inaccurate lab test results. trust between leaders and employees.11,13 an employee recognition program.13,14 All healthcare workers have this potential For example, some leaders may feel to keep patients safe, but not all may feel comfortable allowing employees to make — Consider moving to a just culture.12 empowered to question and investigate autonomous decisions in just a few situa- — Invest in teaching and develop- unusual work patterns or potentially dan- tions, while other leaders may identify a ment of employees to foster their gerous patient care situations. How do broader set of situations in which employ- expertise.12-14 individuals within a team setting achieve ees can make autonomous decisions when — Facilitate periodic sharing of infor- this level of commitment to patient performing their jobs. mation and knowledge about the safety? There are no clear-cut answers; Following are activities that senior lead- organization that helps employ- however, there is growing consensus that ership can engage in with employees to ees understand and contribute a strong patient safety culture within an foster and build a patient safety culture of to the organization’s goals and organization can lead to the empower- empowerment: performance.13,24,25 ment of healthcare workers, improved — Explicitly tell staff to speak up if patient safety climates, error reductions, — Support employees by providing concerned. and successful implementation of quality positive feedback, especially in situ- improvement initiatives11,16-19 ations that are questionable, such as CONCLUSION when employees question or override authority.13,14,23,24 Employee empowerment is an ongoing EMPOWERMENT OPPORTUNITIES — Devote time to listening to employ- process that can improve the delivery of Organizations with a positive safety safe patient care. The challenge for leaders ees and seeking their input on and culture and climate provide work envi- in creating an atmosphere of empower- solutions to identified problems.14,24 ronments that are fair and just, support ment is to change their approach for collaboration across rank and discipline, — When talking with or listening to relating to their employees. This article and support life-long learning.11,17,20,21 employees, give them full attention, provides a list of suggested activities that An example of this model, “just cul- and attend to body language.24 can move an organization toward empow- ture,” is a structured process that uses — Provide clear expectations to employ- ering its employees, which will improve a system approach to evaluate adverse ees; express trust in their ability to employee engagement in delivering safer and near-miss events. It advocates for the make the right decisions.13,14 patient care. Vol. 8, No. 3—September 2011 Pennsylvania Patient Safety Advisory Page 115 ©2011 Pennsylvania Patient Safety Authority O T H E R F E AT U R E S NOTES 1. Kohn LT, Corrigan JM, Donaldson MS. 7. U.S. Department of Health and Human 17. Squires M, Tourangeau A, Spence To err is human: building a safer health Services. Understanding the affordable Laschinger HK, et al. The link between system [online]. [cited 2011 May 31]. Avail- care act [online]. [cited 2011 May 19]. leadership and safety outcomes in hospi- able from Internet: http://www.iom.edu/ Available from Internet: http://www. tals. J Nurs Manag 2010 Nov;18(8):914-25. Reports/1999/To-Err-is-Human-Building- healthcare.gov/law/introduction/ 18. Singer SJ, Falwell A, Gaba DM, et al. A-Safer-Health-System.aspx. index.html. Identifying organizational cultures that 2. National Priorities Partnership. Aligning 8. U.S. Department of Health and Human promote patient safety. 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