Moving toward a Culture of Safety

Ron Collins, MD FRCP(C)

Clinical Quality Lead, BCPSQC

Project Medical Director, ERAS, IH

Co-Chair, Provincial ERAS Collaborative

Anesthesiologist, KGH

@ron_collinsbcps

Culture Impacts Quality

“Between the health care we have and the care we could have lies not just a gap, but a chasm.” Institute of Medicine, 2001

James Reason, 1990

“Professionals should not be afraid to make mistakes. They should be afraid of not learning from the ones they do make.”

Sidney Dekker, “Just Culture; Balancing Safety and Accountability”, 2007

Personal accountability: “Maintain Situational Awareness”

Culture of Patient Safety

Just Culture

Reporting Culture

Learning Culture

Improvement Culture

The Gordian Knot

Create a Loose End!

Culture is what happens when we interact!

“…cultures-and the specific norms that define these

cultures-emerge as unintended byproducts of

interpersonal interaction.” Lehman et al., Ann Rev Psych

2004;55:689-714

Power Distance Index

The higher the power distance in a culture, the less likely those in subordinate roles will question the actions or directions of individuals in authority.

“Power distance is the extent to which the less powerful members of organizations and institutions accept and expect that power is distributed unequally.”

High Power Distance Index Cultures

Those in authority openly use their rank.Subordinates expect clear guidance from above.Subordinates take the blame (Second Victim).The relationship between boss and subordinate is rarely personal.Politics is prone to totalitarianism.Class divisions within society are accepted.

A Tale from St. Elsewhere….Very experienced OR RN

Recent stress leave due to ‘Bullying’

Circulating in Orthopedic OR

In the midst of the ‘Timeout’….

Situational LeadersAny team member who has the skills to manage the situation

“The principle role of a situational leader is to mobilizeand support the Situational Awareness of the team.”

PDI: Mitigation in Communication

•Command

•Team Obligation Statement

•Team Suggestion

•Query

•Preference

•Hint

Culture Impacts Safety and Quality

Culture of Patient Safety

Just Culture

Reporting Culture

Learning Culture

Improvement Culture

Success with CUSP depends on……Situational AwarenessSituational Leadership

Reporting CultureImprovement Culture