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Why every EMS agency needs a stronger safety culture

A strong patient safety culture has the greatest impact on reducing adverse incidents and harm to patients


Health care organizations, EMS included, gradually develop their own unique culture, heritage and values which are passed on to new employees. The culture is, ultimately, driven by the leadership.

Many EMS organizations find their culture is somewhere between a retributive style and an authoritarian type of culture with policies and procedures enforced by punitive measures. This has led to a tradition of not admitting that a mistake was made, since the typical result is the termination of the individual who committed the error.

Errors are causes by human factors and systems design
But are errors truly the result of an individual intentionally wanting to cause harm? Research has shown that many errors in health care are not so much the result of an individual, but rather a compilation of human factors and systems design.

"Medical errors most often result from a complex interplay of multiple factors. Only rarely are they due to the carelessness or misconduct of single individuals," Lucien L. Leape, MD, Harvard School of Public Health, said.

EMS operates at a fast pace and is extremely dependent on reliable systems. When a system or process fails, the outcome is not usually the fault of the provider. However, unless a provider feels safe to come forward and report a process failure it will remain flawed leaving the organization at risk for a patient event. An organization must develop a patient safety culture in which a health care provider feels safe to point out a process that has, or could, fail.

Develop a 'Just Culture' 
Just Culture, a philosophy which looks at the balance between human and system accountability, is a hot topic in safety and in the reduction of errors in today’s medical industry. Implementing this philosophy can make an impact by creating a culture within an organization that encourages open dialog. This allows for mistakes, near misses and adverse events to be openly analyzed without the fear of blame.

Eunice Halverson, MA, Center for Patient Safety Patient Specialist states, "Culture is the atmosphere’created by beliefs and attitudes which shape employee behavior. Developing a strong patient safety culture has the greatest impact on incident reduction. It is the most important factor in laying the foundation for a safe environment for patients and employees."

CPS fully supports the implementation of Just Culture in health care organizations across the continuum of care. The reporting of events is important and necessary to learn how to prevent errors from occurring.

Organizations with cultures that support the open communication of errors while in a non-punitive environment — a just culture — are more likely to see high levels of improvement in patient safety.

Just Culture reshapes our understanding of accountability, the role of the system, and the role of human behavior. It creates a consistent way to promote a safe environment by managing the system and the behavior.

Medicine, aviation and a growing number of other fields have made significant moves toward Just Culture in recent years. This is noteworthy not only because of the successes that have been achieved, but as a dramatic example of cultural shift, because Just Culture contrasts with the traditional culture in health care and other high-risk disciplines, which often held individuals accountable for all errors or mishaps.

Although Just Culture does not hold individuals accountable for system failings over which they have no control, it is not a blame-free model. It acknowledges that humans inevitably make mistakes, and that systems should be designed to reduce the chance of harm in the event of such mistakes (Strategy for a National EMS Culture of Safety).

Halverson acknowledges an organization can begin to improve its culture when leaders are completely dedicated to improving patient safety and when actions emulate what they speak. "If top managers are not on board, patient safety competes with core business operations, such as productivity and profitability — and, unfortunately, patient safety almost always loses."

Halverson issues this reminder to senior leaders, "You are accountable — keep patient safety a priority!" 

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