Elsevier

Critical Care Clinics

Volume 21, Issue 1, January 2005, Pages 31-41
Critical Care Clinics

An irreplaceable safety culture

https://doi.org/10.1016/j.ccc.2004.08.002Get rights and content

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Safety and vigilance

Improving patient safety will require change in multiple aspects of medical practice and hospital organization. The benefit of transparency and patient-centered care to patient safety is evident from the experience of Cincinnati Children's Hospital Medical Center (CCHMC), a participant in the Robert Woods Johnson Pursuing Perfection program, and the reduction in mortality following cardiac surgery, using a team approach, at Concord Hospital [5]. Transparency occurs when the public can use

Interventions to promote a safety culture

Creating a safety culture that is rooted in new practices and ways of learning is complicated. Most leaders, as well as workers, in organizations are frustrated with change efforts …“We are overloaded; I can't get people to pay attention… “If I stop pushing, things stop moving”… “Another taskforce, we just debate the change to death.” In fact, most change efforts fail. For example, in a 1997 study of 272 companies in the United Kingdon, only 33% achieved their strategic objectives.

Recently,

Tools to measure a safety culture

We are only just beginning to develop reliable and valid tools that measure an organization's “reliability” as a setting in which accidents are minimized and recovery from them is facilitated. For example, Singer et al [8] adapted a safety culture survey from five existing surveys (operating room management attitudes, anesthesia work environment, naval command assessment tool, risk management questionnaire, and safety orientation in medical facilities). This survey reviewed 16 topics, including

Summary

ICU clinicians are sources of errors and of resilience. When they learn how to juggle many competing goals, remain vigilant, and tell safety stories— all in the context of changing technologies and demand—, they can create safe settings of care. To be sure, other strategies (eg, such as using computerized tools and implementing safety procedures) are important, but alone they are not sufficient. An ICU needs a safety culture that is rooted in a committed leadership, the acknowledgment that

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This work was supported by Grant No. REA 03-020, Veterans Health Administration, Health Services Research and Development, and Agency for Healthcare Research and Quality UC1 HS014237-01.

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