The Role of Leaders in Developing a Culture of Safety

1. Middle East Forum March 2019 THE ROLE OF LEADERS IN DEVELOPING A CULTURE OF SAFETY Dr. Nicola Ryley Chief Nursing Officer, Hamad Medical Corporation Frank Federico, RPh Vice President, Senior Safety Expert Institute for Healthcare Improvement

2. As part of our extensive program and with CPD hours awarded based on actual time spent learning, credit hours are offered based on attendance per session, requiring delegates to attend a minimum of 80% of a session to qualify for the allocated CPD hours. • Less than 80%attendance per session = 0 CPD hours • 80% or higherattendance per session = full allotted CPD hours • Total CPD hours for the forum are awarded based on the sum of CPD hours earned from all individual sessions. ME Forum 2019 Orientation

3. Disclosure • The presenters have no conflict of interest to disclose

4. Description • A culture of safety is defined as a culture in which the safety of a patient comes before all else, individuals are not afraid to speak, and learning comes from good and bad events. Leaders at all levels of an organization play a significant role in fostering this culture. In this session, we will discuss the behaviors and actions that help foster and maintain this culture.

5. Objectives • Define a culture of safety for your organization • Describe the behaviors and attitudes necessary to foster that culture • List three actions that you will take when you return to your organization to determine your present culture and foster a culture of safety.

6. What is a Culture of Safety? Reflection: what does a culture of safety mean to you?

7. Agency for Healthcare Research and Quality Defines “safety culture” as: The safety culture of an organization is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization’s health and safety management. Organizations with a positive safety culture are characterized by communications founded on mutual trust, by shared perceptions of the importance of safety, and by confidence in the efficacy of preventive measures.

8. Ownership, Responsibility, Just Culture Foundational To Culture Promote environment that supports teamwork Behaviors, Guardian of the Learning System Patients/Families and Staff Engaging Others

9. TRUST

10. The Six Domains Establish a compelling vision for safety Establish organizational behavior expectations Value trust, respect, and inclusion Lead and reward a just culture Select, develop, and engage your Board Prioritize safety in the selection and development of leaders Leading a Culture of Safety: A Blueprint for Success

11. Shaping a Culture • Understand your culture • Determine the attitudes and beliefs that are shaping the existing culture “The culture that exists is the culture that you tolerate” You

12. Why is a culture of safety necessary to improve patient safety? • Role of culture in our work: Impact of culture on outcomes Medium Teamwork Score Medium Teamwork Score Low Teamwork Score NO blood stream infections for 5 consecutive Frankel, Safe and Reliable Care

13. Elements of a Culture of Safety • Make safety as a core value- establish a compelling vision • Provide strong leadership at all levels • Value trust, respect, and inclusion • Establish organizational behavior expectations- vital behaviors

14. Elements of a Culture of Safety • Be reluctant to simplify- focus on the root problem • Empower individuals to successfully fulfill their safety responsibilities

15. BRAVING • Boundaries – knowing and respecting in self and others • Reliability - consistency • Accountability – for own behavior • Vault – two doors, holding in confidence • Integrity – courage/comfort, right/easy, practice/profess • Non-judgement – of self and others • Generosity – assuming the best but holding to account Berne Brown, The Anatomy of Trust

16. Behaviors expected from leaders at HMC • Visible • Approachable and able to engage staff at all levels • Balanced and just in decision making based on best evidence • Patient, Family and Staff focused • Setting an example as role model for a culture of safety • Effective communication skills at all levels • Accountable

17. Psychological Safety • “Psychological safety is a belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns or mistakes.” • Team members feel safe to take risks and be vulnerable in front of each other Amy Edmundson Google Team

18. Developing Psychological Safety Primary responsibility of leaders, continuously modeled everywhere. Leaders model and expect the behaviors that promote psychological safety In some units it feels safe to speak up and voice a concern Personality dependent – it depends who I’m working with Fear based – keep your head down and stay out of trouble GENERATIVE Organization wired for safety and improvement PROACTIVE Playing offense - thinking ahead, anticipating, solving problems SYSTEMATIC Systems in place to manage hazards REACTIVE Playing defense – reacting to events UNMINDFUL No awareness of safety culture

19. What does it take to develop psychological safety? HMC action • Close working with Corporate Quality and HHQI • Action plan linked to the IHI white paper • Using examples of good practice within the corporation • Examining the challenges and evidence to overcome • Engaging staff at all levels with listening and engagement events • Ensuring a just culture and system learning is a key priority for HMC

20. Accountability • Each individual is accountable to others for acting in ways that embody organizational values, and each individual is accountable as a team member to be committed, self-managing, competent, and courageous • The organization is accountable for treating individuals fairly and justly “when things go wrong

21. Accountability • Examples: hand hygiene, communicate with team, follow existing guidelines, etc……… • We know how we will be held accountable for our actions (fair and just culture)

22. Accountability in a Fair and Just Culture • Clear and simple rules: “one set” that apply to everyone (no one is “special”) • Four questions for every situation: • Was there malice involved? • Was the individual knowingly impaired? • Was there a conscious unsafe act? • Did the person(s) make a mistake that someone of similar skill and training could make under those circumstances? • Challenges to anticipate: • Implementing for all layers of the organization • Making it “the way we do business” Michael Leonard, MD - Safe and Reliable

23. Role of leaders at HMC on developing accountability and a just culture • Ensuring this remains a corporate priority • Ensuring these are key values for HMC at all levels • Ensuring a consistent approach to review with the emphasis on system learning. • This is a cultural journey and will take time to embed

24. Teamwork and Communication

25. Effective Teamwork GENERATIVE Organizational Culture “Genetically-wired” to produce safety Highly functional teams with systematic, continuous learning PROACTIVE “We methodically anticipate”— prevent problems before they occur Methodical implementation and reinforcement of team behaviors SYSTEMATIC Systems being put into place to manage most hazards Teamwork tools and training available, partial adoption REACTIVE “Safety is important. We do a lot every time we have an accident” Awareness and teamwork training after adverse events is the norm UNMINDFUL “We show up, don’t we?” Chronically Complacent Individual expert model – “Just do your job and everything will be fine”

26. Teamwork Actions • Huddles • Plan forward • Reflect back • Communicate clearly • Resolve conflict

27. Actions of HMC to promote teamwork • Building Capacity and Knowledge • Sharing good practice • Focus on learning culture • Focus on system wide learning and engagement of staff at all levels