Building a Culture

of Safe & Highly

Reliable Care

Providence OregonMichael Leonard, MD

Context

Loss of control - less voice or influence

Feeling less valued

Cultural change the wrong direction -

Burnout increasing / resilience decreasing

Disconnect of demand & resources to do the work

Alignment and clarity between organizational and caregiver

values

Success - Simple but Hard

Psychological safety – having a voice

Feeling valued

Having the tools and resources to do your job

Reliable processes of care

Learning System – when issues and concerns are raised,

they are acted upon in a visible, measurable manner

Your Turn

What are the current strengths of your culture?

Where are the weaknesses and opportunities?

What visible actions are being taken in this regard?

How often does your safety culture data get

translated to visible action and improvement?

UNMINDFULWho cares as long as we’re not caught

Chronically Complacent

REACTIVESafety is important. We do a lot every

time we have an accident

SYSTEMATICWe have systems in place to manage all

hazards

PROACTIVEAnticipating and preventing problems

before they occur; Comfort speaking up

GENERATIVESafety is how we do business around here

Constantly Vigilant and Transparent

Va

lue

TIPPING POINT

Cultural Maturity Model

*Adapted from Safeskies 2001, “Aviation Safety Culture,” Patrick Hudson, Centre for Safety Science, Leiden

University©SRH 2017

Unmindful • Reactive • Systematic • Proactive • Generative

Transparency

Leadership

Psychological

Safety

Conflict

Resolution

Teamwork &

Communication

Just Culture

Reliability

Improvement

Continuous

Learning

Patient

&

Family

Centered

Care

Courtesy IHI & SRH

Learning is visible

7

Why is Culture Important?

Culture reflects the behaviors and beliefs

within an organization.

There are behaviors that create value;

behaviors that create unacceptable risk.

Culture is the social glue

Work as Imagined v. Work as Done

©SRH 2017

Why Integrated Culture Measurement ?

9

Courtesy Dr. Bryan Sexton, Duke University©SRH 2017

SafetyScore

© 2008 Pascal Metrics

28 33 36 41 45 45 49 49 51 52 55 62 6273 75 80

98

020406080

100

CC

U

RE

HA

B

OR

EM

ER

G

5 W

ES

T

6 W

ES

T

PE

DS

GE

RI

DIA

LY

SIS

PE

RIO

P

PH

AR

M

3W

ES

T

ICU

NIC

U

SIC

U

PE

DS

OB

Teamwork Climate Scores Across Facility

HCAHPS 9250

Medication Errors per Month 2.06.1

Days between C Diff Infections 12140

Days between Stage 3 Pressure Ulcers 5218

Illustrative Data:

Extracted from

Blinded Client Data

CULTURE IS RELATED TO…

28 33 36 41 45 45 49 49 51 52 55 62 6273 75 80

98

020406080

100

CC

U

RE

HA

B

OR

EM

ER

G

5 W

ES

T

6 W

ES

T

PE

DS

GE

RI

DIA

LY

SIS

PE

RIO

P

PH

AR

M

3W

ES

T

ICU

NIC

U

SIC

U

PE

DS

OB

Teamwork Climate Scores Across Facility

Employee Satisfaction 9155

Employee Injury per 1000 days 0.116

Employee Absenteeism per 1000 days 1015

RN Vacancy Rate 19

<60% Score =

Danger Zone

Illustrative Data:

Extracted from

Blinded Client Data

……AND EMPLOYEE OUTCOMES

H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12

Lo

ca

l L

ea

de

rsh

ip a

nd

Psych

olo

gic

al S

afe

ty

% P

ositiv

e

Re

sp

on

se

Months between

Wrong Sites Surgeries or

Retained Foreign Bodies6 12 40

Where Would You Rather Have An Operation?

©SRH 2017

Leadership

Why is meaningful feedback important to you

and the organization ?

Local Leadership Item

UNNAMED HEALTH SYSTEM –NOT YOU

Culture and Leaders

MI = Michigan

EWR = Executive WalkRounds

FB = Feedback

Teamwork Domain – System Level

Percentage who agreed slightly or agreed strongly with each question.

NOT YOU

Teamwork Domain – By Role Type

Percentage who agreed slightly or agreed strongly with each question.

Teamwork Item

Providence Oregon

Providence Health & Services Oregon Results

Survey Item: In this work setting,

it is difficult to speak up if I perceive

a problem with patient care. PHSOR

Response

Rate PHRMH PMH PMMC PNMC PPMC PSH PSVMC PWFMC Ambulatory

Position Type

All Respondents 71%71%

(13,633 of 19,115) 66% 77% 69% 67% 67% 70% 69% 72% 72%

Adv. Practice RN 75%67%

(26 of 39) 60% ND ND 67% 75% 57% 65% ND 68%

Clerical/Administrative 67%79%

(2,913 of 3,710) 61% 73% 71% 65% 68% 75% 66% 77% 67%

Enviromental Services/Food

Service/Plant Operations 49%65%

(457 of 706) 36% 73% 71% 50% 42% 40% 47% 57% ND

Management 84%82%

(1,070 of 1,301) 94% 78% 90% 83% 84% 100% 84% 89% 85%

Non-Clinical Technician 67%73%

(233 of 321) 67% ND 36% 80% 44% ND 64% 50% 100%

Patient Care Support 66%73%

(2,361 of 3,248) 59% 70% 68% 63% 66% 70% 64% 71% 64%

Physicians 81%38%

(652 of 1700) 72% 70% 74% 67% 73% 92% 82% 73% 85%

Physician Assistants 87%48%

(83 of 173) ND ND ND ND ND ND 71% ND 90%

Physician Resident/Fellow 71%58%

(38 of 65) ND 79% ND ND ND ND 64% ND 100%

RN-Direct Care 70%75%

(2,829 of 3,794) 70% 76% 63% 71% 67% 63% 69% 75% 75%

% Favorable Response

Safety Attitudes Questionnaire

Teamwork Item

Teamwork Item

SummaryCulture is measurable, observable and actionable Having a

sphere of influence – voice - is essential

Don’t ask people what they think if you’re not going to take

visible action

Make the work granular and relate it to the specific behaviors

they engage in every day

In absence of a healthy culture, habitual excellence is not

possible