A thousand little things — the culture of safety

Steve Muething, MD, patient safety officer at CCHMC, knows it’s both big and little things that combine to create a culture of safe medical care

People sometimes ask, “What’s the one big thing you do to create a culture of safety at your medical center?”

There isn’t one, I say. Building a culture of safety seems to be a combination of a few big things and thousands of little things.

The big things seem to get noticed, but I have been thinking lately that it is probably the thousands of little things that really are what the culture of safety is all about.

Big things at Cincinnati Children’s have included the Patient Safety Tracker on our Intranet and setting a goal to reduce Serious Safety Events three years ago. We have changed our overall approach to the root cause analysis when such an event occurs. We trained all staff and leaders on error prevention and started a safety coach program. The Simulation Center has grown significantly, and the Board of Trustees receives a report on patient safety every month. All of these are big things, and visitors can see these changes when they come to learn from us.

I really want to show them the thousands of little things that seem to be making the difference, too. I want to show them a Child Life specialist filling out a safety report about a concern she noticed in an outpatient clinic; and I’d show them nurses checking an IV together at change of shift to help reduce the risk of the child being harmed.

Patient Safety is an important part of our Intranet

Of course, I’d want to show them a team discussing a child’s monitor on rounds to make sure we had the best possible settings for this child. Then we’d drop by the neonatal ICU to show them a family being asked if they had any safety concerns each and every time they leave in an effort to make parents more and more comfortable to speak up when they do have concerns.

I’d ask them to stop by after midnight to see unit leaders reviewing every patient to make sure the leaders were all on the same page about who may be at increased risk. They would need to be here early in the morning to see nurses using checklists to make sure every child heading for surgery has everything correct.

They could see pharmacists verifying high risk medications to decrease the chance of an error. If we walk around a unit, we’d see a nurse or intern telling their supervisor that something just didn’t seem right about a patient and they need another “set of eyes” to check. In the emergency room, they would see staff congratulating each other on safety catches.

They’d sense that people know risks are everywhere so it is important to give positive feedback. I’m sure they would hear great stories from safety coaches who volunteer to keep all of us learning how best to keep our patients safe.

We’d have to spend some time with families. I would bet they’d hear some parents tell how they feel a difference here at Cincinnati Children’s. They might talk about how safety seems to be on everyone’s mind.

We’d also hear from some families who are still scared and likely hear about how errors still seem to happen too often. These parents would remind all of us the journey toward a culture of safety is never over and we need to continuously improve.

Forever.

Stephen Muething, MD, is a Pediatrician and Associate Professor at the University of Cincinnati and Cincinnati Children’s. He has recently taken on a leadership role as Vice President of safety at Cincinnati Children’s because of his experience in design for reliability and high reliability organizations.