Safe patient care - safety culture and risk management in otorhinolaryngology

Abstract

Safety culture is positioned at the heart of an organization's vulnerability to error because of its role in framing organizational awareness to risk and in providing and sustaining effective strategies of risk management. Safety related attitudes of leadership and management play a crucial role in the development of a mature safety culture ("top-down process"). A type marker for organizational culture and thus a predictor for an organization's maturity in respect to safety is information flow and in particular an organization's general way of coping with information that suggests anomaly. As all values and beliefs, relationships, learning, and other aspects of organizational safety culture are about sharing and processing information, safety culture has been termed "informed culture". An informed culture is free of blame and open for information provided by incidents. "Incident reporting systems" are the backbone of a reporting culture, where good information flow is likely to support and encourage other kinds of cooperative behavior, such as problem solving, innovation, and inter-departmental bridging. Another facet of an informed culture is the free flow of information during perioperative patient care. The World Health Organization's safe surgery checklist" is the most prevalent example of a standardized information exchange aimed at preventing patient harm due to information deficit. In routine tasks mandatory standard operating procedures have gained widespread acceptance in guaranteeing the highest possible process quality. Technical and non-technical skills of healthcare professionals are the decisive human resource for an efficient and safe delivery of patient care and the avoidance of errors. The systematic enhancement of staff qualification by providing training opportunities can be a major investment in patient safety. In recent years several otorhinolaryngology departments have started to incorporate stimulation based team trainings into their curriculum.

Keywords: incident reporting; risk management; safety culture; standard operating procedures; team training.

Table 1. Different phases and corresponding aspects of safety culture (according to [19]).

Table 2. Patterns of behavior allowing the surgeon to strengthen the teamwork. The properties mentioned in the behavioral marker system NOTSS (NOnTechnical Skills for Surgeons) can be taught specifically in the context of team trainings (according to [38]).

Table 3. Patterns of behavior allowing the single staff members to strengthen the teamwork. The properties mentioned in the behavioral marker system OTAS (observational teamwork assessment for surgical teams) can be taught specifically in the context of team trainings (according to [38]).

Figure 1. Framework model for the development of safety culture (based on [11], with kind approval of Springer Publishing). The increasingly open management of critical information and the growing confidence within an organization leads to a higher degree of maturity of an organization.

Figure 2. Double function of an incident reporting system. Staff members submit safety-relevant incidents in an anonymised way. The information contained in the report is analyzed and from the multitude of possible reactions a locally feasible solution is chosen. Taken measures or current status of the assessment are communicated to the staff. At the same time care is taken that the knowledge is durably noted in the organization (organizational learning).