Building Your Culture of Safety by Breaking Down Barriers

Patient Safety Quality Monthly

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November 25, 2009

Are you busting barriers? No, not those good barriers that prevent harm, but those nasty barriers that separate silos and departments. Have you involved your facilities, engineering and maintenance folks in your culture of safety? How about your relationship between quality and risk management? What about the IT department? These areas are ripe for some "barrier busting" if you want to increase the speed of improvement of your culture of safety and reliability.

The more I work with organizations to build their culture of safety, the more striking to me the number of missed opportunities of not getting your facilities and engineering folks more actively involved. Sometimes we just don't think about the non-clinical expertise within these areas. On the clinical side, we are thinking about performing FMEAs to reduce risk. Do you know that the facilities/engineering and maintenance folks are likely performing maintenance risk and prioritization analysis? That's how they decide whether they need to spend the resources to replace something or fix it or whether they should just wait. In addition, they are doing HAZWOP analysis to evaluate hazardous waste operations, yet another risk assessment activity.

In addition, you may find that your engineering team has some real skills in planning and tracking tasks as part of project management. Often, the clinical side is a little weak in managing projects and activities, whereas this is likely a real strength on the engineering side. Consider getting internal assistance from our teammates in the other departments. Ask them whether they can help with setting up some action tracking systems or project scheduling approaches, as they may have the software and people who are good at such tasks.

Another area to take advantage of is change management. With all the process changes we are putting into play, how do we make sure the changes will deliver the benefits we expect without any unexpected consequences? Consider talking with your IT folks about how they manage changes to the software systems. You may get some great ideas from their methods—and if you don't, maybe you just uncovered an area of concern!

Another key silo closer to home is the working relationship between the risk management and quality departments. All those occurrence reports are some of the most valuable quality data we have—make sure they are getting shared. If your occurrence reports are not being effectively used, you are letting an organizational barrier put your culture of safety efforts at risk. Break down that barrier quickly!

So if you want to develop a more integrated approach to improving your culture of safety and reliability, consider the following:

1. Combine forces with facilities/engineering on your FMEA program
2. Make sure your expectations for safe behaviors are shared between both the clinical and non-clinical areas
3. Learn from the project management and action-item tracking systems that are in place in engineering, maintenance, and bio med
4. Work with members of IT to learn how they manage change
5. Get your risk managers and quality people to share data

Building our culture of safety is a continuously ongoing effort; we have to keep pushing and adjusting and working on all aspects of building an effective culture of safety and reliability. Some parts are easy to address, some seem almost impossible, and then there are some important things that we can do but they take some effort—busting some barriers is a good place to start.

Ken Rohde 11/25/2009

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