Are healthcare organizations that enact cost-cutting measures endangering their patients? Surgeons at a Florida hospital made national news when they raised the issue recently.
Expecting flawless performances from human beings working in high-stress, complex environments like hospitals is unrealistic, says Heidi Raines (www.performancehealthus.com) author of Shared Voices: A Framework for Patient and Employee Safety in Healthcare.
That’s why it’s essential to have processes in place for sharing observations about unsafe conditions, reporting errors, and reducing safety incidents, she says, especially when cost-cutting has increased the risk to patients.
“Establishing and maintaining a culture in which employees and patients feel comfortable and empowered to speak up about unsafe conditions requires a clear-eyed and courageous look at the imperfect and uncomfortable parts of our environments of care,” Raines says. “This requires a commitment to listening, learning, and adjusting our practices intentionally and incrementally.”
Raines says healthcare leaders must focus on the following three points to foster a culture that recognizes reporting as a tool for learning and prevention and, as a result, improves patient and employee safety:
a) Encourage broad staff input. Staffing shortages have hampered healthcare facilities in recent years, and the situation has grown worse in the wake of COVID as burnout has led to the exodus of many healthcare workers. Raines says being stretched thin has exacerbated stress on the remaining workforce and made errors more likely. And along with the added pressure to perform their tasks while hospitals and other healthcare facilities are slammed with patients, Raines says workers can feel enormous pressure when reporting errors or safety issues they’re aware of.
“Some caregivers don’t want to ruffle feathers or get ostracized by peers or managers, so they stay silent or communicate little about errors and potential dangers they’ve witnessed,” Raines says. But that tendency to keep safety issues to themselves, she adds, can further place patients at risk as process gaps are either ignored or not appropriately addressed to prevent harm from occurring.
“Staff input is one of the most valuable tools in healthcare,” Raines says. “Frontline caregivers, in particular, see it all. The more proactive they become about sharing observations, the safer our patients – and employees – will be. It’s only when we voice our observations and concerns in our work environments, when we listen to what others have to say about their experiences, and when we honor the findings that result from careful and thorough analysis that we can prevent safety issues in the most effective way possible.”
b) Don’t wait for a serious safety incident; report all unsafe conditions. Raines says the shift toward preventing safety incidents in hospitals requires that healthcare workers pay as much attention to unsafe conditions and near-misses – and quickly report them – as to more serious safety incidents.
“The great value of reporting near-misses and unsafe conditions is that they provide organizations with a fuller picture of what can be done to improve patient and employee safety,” Raines says, “and they encourage more reporting of potential areas of risk before they become full-fledged incidents.”
c) Foster an environment where healthcare workers feel heard and supported. Healthcare leaders should empower workers to speak up, Raines says. “Be ready to listen and respond to them,” she says. “Leaders must get it through to their staff that each one of them must become part of the evolutionary process, one in which protecting lives is considered important enough to set aside any stigmas and negativity around reporting.”
The goal for all healthcare facilities and workers, Raines says, should be to embrace near-miss and event reporting as “a chance to pay forward what we learn by actively participating in incident prevention, and to have the courage to share their observations and discoveries, thus reducing the silence that surrounds safety work in our healthcare systems.”
“Only when we speak up, learn, and adjust our practices intentionally and incrementally will we make strides toward better care, lower costs, healthier employees, and safer patients,” Raines says.
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