Using such measures, studies have demonstrated a relationship between safety culture and a variety of patient outcomes. For instance, evidence suggests that perceptions of safety culture are related to readmission rates of cardiac patients, length of stay for intensive care unit patients, postoperative complication rates, medication errors, patients’ perceptions of care, and safety incidents. Further, a positive safety culture may be a prerequisite for attaining safety goals, such that organizations with a favorable safety culture in place may be more likely to adopt new safety practices and have a better chance that those practices will take hold. As such, there is increasing interest in identifying the practices that lead to improved safety culture and evaluating their effectiveness. BEFORE MOVING ONTO THE NEXT SECTION, PLEASE COMPLETE CASE STUDY 6.
Cultural competency While there is not a single definition of cultural competency, a frequently cited definition, referenced by AHRQ, U.S. Department of Health and Human Services and others, comes from an early article by Cross et al. (1989), 132 who described the practice as, “A set of congruent behaviors, attitudes, and policies that come together in a system or agency or among professionals that enables effective interaction in a cross-cultural framework.” Historically, cultural competency consisted of teaching providers about different cultural groups. More recent pedagogy takes into account the dynamic nature of culture, in addition to intragroup variability, and social determinants of health such as socioeconomic status. Rather than categorizing and learning about different cultural groups, a more effective strategy is to teach providers skills that can be applied in any cross-cultural situation. Additionally, in recent years, there is greater focus on provider and organizational self-reflection, current and historical racism (and other forms of oppression), as well as structures of power and privilege, and how biases impact care.
While early understanding of cultural competency was limited to the provider/interpersonal level, the scope of cultural competency now includes the organizational and systems domains. For example, the U.S. Department of Health and Human Services established a framework for cultural and linguistic competency: The National Standards for Culturally and Linguistically Appropriate Services (CLAS) standards. 133 According to the CLAS standards, organizations that are culturally competent provide “effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.” Cultural competency is often framed as a best practice and as an achievable response to health and healthcare disparities in minority populations; it is also deemed an important practice in the context of increasing diversity in the U.S. population. The literature on cultural competency as a patient safety practice is limited; however, evidence suggests a link between provider and organizational cultural competency and patient safety.
Instructions: Spend 10 minutes reviewing the case below and considering the questions that follow. Case Study 6: Leadership WalkRounds
Leadership WalkRounds are tools that executives and leaders can use to: increase awareness of safety; demonstrate their commitment to (and the importance of) safety; reinforce safety behaviors and concepts such as speaking up and non-punitive reporting; and gather and help solve patient safety– related issues. As the term implies, this tool involves leaders “walking around” to engage in face to face, candid discussions with frontline staff about patient safety incidents or near-misses. Leadership WalkRounds vary in the way they are implemented, including the composition of the WalkRound team, the frequency with which WalkRounds are used, the degree of structure that each WalkRound follows (e.g., whether a standard set of questions is used), and the degree to which the WalkRound team communicates the issues raised and the potential solutions identified to the rest of the staff. In 2002 the University of Michigan Medical Center instituted a version of WalkRounds in which the chief of staff met with caregivers every other week on individual patient care units. 131 Staff attendance was voluntary and confidential. The chief of staff opened meetings with the following statement: “As you know, we’re trying to move as an organization to more open communication and we’re trying to develop a blame-free environment. We’re doing this because we think this is the only and best way to make the environment safer for everyone who works here and for all of our patients. First, we’re interested in focusing on our systems, not on individuals. In keeping with this, please know that everything you say is confidential and peer review protected. If you have any concerns, please let us know. As we discuss patient safety, please keep in mind the many areas to which these questions might apply, including medication errors, miscommunication between individuals, distractions, inefficiencies, protocol violations, and any others you can think of.” Over a span of four years 70 such meetings took place. In a comparison of staff who had participated in the WalkRounds and those who did not, staff who experienced the WalkRounds were more likely to report errors or near-misses and were more likely to perceive that their manager promotes patient safety and is non-punitive in response to staff errors. In addition, these staff members felt a greater sense of teamwork within their unit.
1. Do you think this or some variation on a WalkRound would be feasible at your place of work? Why or why not?
2. What might be some potential barriers to implementing a WalkRound at your place of work?
3. How might patient safety be improved by instituting some kind of WalkRound at your place of work?
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