A Physician Office Guide to Creating a Culture of Safety

Physician offices are not risk-free zones for patients.

The reality is that liability risks are created every day in your office practice.

LHA Trust Funds Director of Patient Safety Caroline Stegeman states that risks patients are most likely to encounter fall into one of these five categories:

• Quality of Care
• Communication
• Documentation
• Medication Safety
• Environmental Safety

The key to reducing these risks? Creating a culture of safety within your office practice.

Why Should A Physician Create A Culture of Safety?

ECRI, an independent nonprofit organization that focuses on improving the quality, safety, and cost-effectiveness of healthcare, defines a culture of safety as “an organization's shared perceptions, beliefs, values, and attitudes that combine to create a commitment to safety and an effort to minimize harm.”

“Your staff members are the eyes and your ears in your organization,” says Stegeman, an RN with 13 years of clinical risk management experience specializing in risk management, patient safety issues, and medical malpractice claims. “You want them to feel comfortable enough that when they hear something, they also say something.”

The overall culture of your practice needs to be one where leaders create and maintain an environment where employees feel comfortable enough to speak up about incidents, concerns, occurrences, near misses, and opportunities for improvement.

Step 1: Setting Goals

Ultimately, creating and maintaining a culture of safety sets a goal for your office practice to become more mindful about patient safety. Some risks may seem harmless but, left unattended, could turn into patient injury or even a liability claim.

Start by thinking closely about a past situation that has occurred around patient safety and what could have been done better. Use this assessment to derive a goal or set of goals for your practice. Working on one goal at a time can be more manageable as you develop your plan.

Our Physician Office Practice toolkit curates resources specifically for your risk concerns. Start with our self-risk assessment tool, which is designed to help physician office practices establish a baseline for their risk management concerns and create a plan of action to address them.

Step 2: Breaking the Employee Cycle of Fear in Reporting

Staff may be afraid to report near misses or other issues in the office practice because they fear “being sued” or even being fired. Developing ­a non-punitive reporting environment will help put those fears to rest and give staff confidence in reporting errors.

A non-punitive, or blame-free, reporting environment takes time to create. This type of environment is nurtured by a reporting culture built through actions, not just a policy to be followed.

Ultimately, the focus should be on the systems that failed during an incident rather than blaming an individual who made a mistake. Your staff members need to feel that they will not be the focus of an error investigation, lose their job, or be retaliated against.

However, a blame-free reporting environment does not mean that employees should not be held accountable in cases of willfully neglecting existing policies or willful harm.

Step 3: Employee Training & Communication is Key

Processes for initial and ongoing staff education are also helpful in creating and maintaining a culture of safety. Orientation and annual training are often not sufficient to address patient safety issues within your practice.

Monthly meetings, educational newsletters, emails, and daily huddles can establish touchpoints for your staff to refresh themselves on your practice’s policies. In the case of a daily huddle, Stegeman says, your staff members can quickly discuss your patient load for the day and any safety concerns to be aware of.

“You want to say, ‘okay, we have some safety issues coming in.’ So-and-so uses a walker. So-and-so is in a wheelchair,” Stegeman says. “You want to have those daily huddles to discuss how to handle the patients and educate everyone on who is coming in that day along with what issues they may be having.”

Step 4: Measuring Your Results

Running a search query for “culture of safety” turns up all manner of results, nearly all of which are hospital-focused. So you may be thinking, how does this apply to my office practice? I have a small staff, no risk manager, and no formal risk management program to speak of.

Many of the tools designed for hospitals can also apply to physician office practices. For example, most organizations pursuing a culture of safety start by surveying their employees. They then re-survey every 18-24 months to benchmark their progress. This information can be a foundation for creating formal risk management policies and reporting processes that will increase the feeling of security for your staff members.

Our High Reliability and Culture of Safety toolkit contains tools to guide you through the culture of safety process, including a video demonstration, education, monitoring assessments, podcasts, articles, webinars, and more.

Questions?

Have questions about starting a culture of safety?

Use our handy Culture of Safety downloadable infographic.

Contact your LHA Trust Funds safety consultants to start a conversation about how we can help you manage your patient safety risks today.

About The Author

Caroline Stegeman has 30 years of nursing and clinical risk management experience in a variety of healthcare settings. She has extensive experience in the management and handling of patient safety issues/ incidents, clinical and environmental risk assessments, root cause analysis, regulatory and industry best practices (TJC, CMS, DHH), hospital emergency preparedness and disaster management and quality improvement initiatives. She is also a member of the American Society of Health Care Risk Managers (ASHRM), Louisiana Emergency Preparedness Association (LEPA), and the National Patient Safety Foundation (NPSF).