psl 503: unit 2 organizational culture: how does it impact patient safety?

PSL 503: PSL 503:

Unit 2Unit 2

ORGANIZATIONAL CULTURE: ORGANIZATIONAL CULTURE:

HOW DOES IT IMPACT PATIENT HOW DOES IT IMPACT PATIENT

SAFETY?SAFETY?

PRESENTATION OVERVIEWPRESENTATION OVERVIEW

• CHARACTERIZING ORGANIZATIONAL CULTURE

• CHARACTERIZING SAFETY CULTURE

• HOW CULTURE IMPACTS SAFETY

– Cultural Blind Spots

– Cultural Entrapment

– Behavioral Commitment

• ASSESSING SAFETY CULTURE ( LISTEN TO DR JAMES BATTLE’S INTERVIEW)

2Shirley E Kellie, MD, MSc

ORGANIZATIONAL CULTURE[OPERATIONAL DEFINITIONS]

• “(organizational) culture enables sustained collective action by providing people with a similarity of approach, outlook and priorities.” 1

• “shared values, norms and assumptions”1

• “what we expect around here.”1

1 Weick KE, Sutcliffe KM. CMR 2003; 45(2):73-84, p 73.


ORGANIZATIONAL CULTURE[OPERATIONAL DEFINITIONS]

• ““those attitudes, assumptions, and those attitudes, assumptions, and values which condition the way in which values which condition the way in which individuals and organizations work.”individuals and organizations work.”11

11 Learning from Bristol. (Crown Copyright 2002), p 266. Learning from Bristol. (Crown Copyright 2002), p 266.


ORGANIZATIONAL SAFETY ORGANIZATIONAL SAFETY CULTURE CULTURE

• “Safety culture has recently emerged in the healthcare literature to describe the set of assumptions and practices necessary for healthcare organizations to provide optimal care.”1



ORGANIZATIONAL SAFETY CULTURE

• ““The Advisory Committee on the Safety of The Advisory Committee on the Safety of Nuclear Installations provides the following Nuclear Installations provides the following definition of safety culturedefinition of safety culture11 – The safety culture of an organization is the product of The safety culture of an organization is the product of

individual and group values, attitudes, perceptions, individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determines competencies, and patterns of behavior that determines the commitment to, and the style and proficiency of, an the commitment to, and the style and proficiency of, an organization’s health and safety management. organization’s health and safety management. Organizations with a positive safety culture are Organizations with a positive safety culture are characterized by communications based on mutual characterized by communications based on mutual trust, by shared perceptions of the importance of safety trust, by shared perceptions of the importance of safety and by confidence in the efficacy of safety measures.”and by confidence in the efficacy of safety measures.”

11 Nieva VF. Sorra J. Qual Saf Health Care 2003;12:ii17-ii23, p ii18. Nieva VF. Sorra J. Qual Saf Health Care 2003;12:ii17-ii23, p ii18.


HOW CULTURE IMPACTS HOW CULTURE IMPACTS SAFETYSAFETY

• To understand how organizational culture To understand how organizational culture impacts safety, it’s essential to consider four impacts safety, it’s essential to consider four constructs and their interdependencies:constructs and their interdependencies:– Organizational CultureOrganizational Culture

– Perception and Interpretation of PerformancePerception and Interpretation of Performance

– Behavior (Actions)Behavior (Actions)

– Organizational PerformanceOrganizational Performance

•



• At the organizational level, safety can be At the organizational level, safety can be considered as a characteristic, or dimension, considered as a characteristic, or dimension, of organizational performance. of organizational performance.


LOW SAFETY

HIGH SAFETY


• Individuals in organizations perceive and Individuals in organizations perceive and interpret the organization’s performance, interpret the organization’s performance, including the organization’s safetyincluding the organization’s safety

• To assure optimal performance (hence safe To assure optimal performance (hence safe care), individuals/organizations need to care), individuals/organizations need to perceive and interpret performance (safety) perceive and interpret performance (safety) accurately. accurately.



• Organizational culture impacts the perception Organizational culture impacts the perception and interpretation of performance including and interpretation of performance including its safety .its safety .



• Perception and interpretation of performance in turn impact behavior and organizational performance.


HOW CULTURE IMPACTS HOW CULTURE IMPACTS SAFETYSAFETY[“DOWN THE WRONG PATH”] [“DOWN THE WRONG PATH”]

• “The same shared values, norms and assumptions can also be a source of danger if they blind the collective to vital issues or factors important to performance that lie outside the bounds of organizational perception. Cultural blind spots can lead the organization down the wrong path, sometimes with dire performance consequences.”1


Shirley E Kellie, MD, MSc 12

HOW CULTURE IMPACTS SAFETY[CULTURAL BLIND SPOTS]

• Culture may distort the organization’s perception of its actual performance leading to cultural blind spots


HOW CULTURE IMPACTS SAFETY[MISPERCEIVING PERFORMANCE]


HOW CULTURE IMPACTS SAFETY [CULTURAL ENTRAPMENT]

• Cultural entrapment is the “process by which people get locked into lines of action, subsequently justify those lines of action, and search for confirmation that they are doing what they are supposed to be doing. When people are caught up in this sequence, they overlook important cues that things are not as they think they are.”1



HOW CULTURE IMPACTS SAFETY[CULTURAL ENTRAPMENT][CULTURAL ENTRAPMENT]


“Commitment binds an individual to his or her behavior. The behavior becomes an undeniable and unchangeable aspect of the person’s world, and when he makes sense of the environment, behavior is the point on which constructions or interpretations are based. This process can be described as a rationalizing process, in which behavior is rationalized by referring to features of the environment which support it. Such sensemaking also occurs in a social context in which norms and expectations affect the rationalizations developed for behavior, and this can be described as a process of legitimating behavior. People develop acceptable justifications for their behavior as a way of making such behavior meaningful and explainable.”1

1 Salancik GR et al. Administrative Science Quarterly 1978; 23 (2):224-253.17Shirley E Kellie, MD, MSc

HOW CULTURE IMPACTS SAFETY[BEHAVIORAL COMMITTMENT][BEHAVIORAL COMMITTMENT]

HOW CULTURE IMPACTS SAFETY[BEHAVIOR AL COMMITMENT][BEHAVIOR AL COMMITMENT]


psl 503: unit 2 organizational culture: how does it impact patient safety?

Documents

positive safety culture

importance of safety

safety management

efficacy of safety measures

impact patient safety

organizational level

msc slide

organizations performance