First, Do No Harm (to Yourselves): Creating a Culture of Employee Safety

Best Practices for Creating a Culture of Safety
In current literature, there are several practices identified to be contributors to producing a culture of safety: creating a just culture, safety reporting systems, transparency, leadership and frontline engagement, employee safety, and a focus on quality improvement. The presentation of these practices in many unique research articles demonstrates that these practices are evidenced-based and serve as best practices for improving safety. The particular practices, which will be examined here, were selected because they are broadly accepted as manners in which to improve safety.

Just Culture
Literature underscores the importance of a “just culture” (Gandhi, 2018), in which healthcare workers are supported when they bring up safety concerns rather than punished. Dr. Mark Jarrett, the chief quality officer at Northwell Health in New York, points out that in order for employees to feel comfortable expressing safety concerns or reporting safety events, they must feel that their reporting will not lead to negative repercussions (Jarrett, 2017). A just culture focuses on accountability for all members of the healthcare team, from the frontline staff up to executives.

Everyone in the organization must embrace this just culture. Frontline leaders, informal or formal, are intricately involved in patient care, and thus, have a strong understanding of safety needs and barriers to safety. When frontline leaders respond in a supportive manner after safety events, they demonstrate a just culture through their actions and thus contribute toward a supportive safety culture in their clinical area (Tarantine, 2017).

Safety Reporting Systems
Additionally, literature emphasizes the importance of implementing safety reporting systems to achieve a culture of safety. Dr. Mary Gregg, the chief medical officer of MAG Mutual Insurance, reported the importance of learning from safety incidences reported through safety reporting systems (Gregg, 2013). Dr. Gregg emphasizes the importance of documenting “near misses,” (Gregg, 2013) which are circumstances in which a negative safety event could have happened but was avoided. A safety reporting system alone is not enough; staff who review safety data must act quickly to make changes after safety events. By responding quickly, healthcare workers demonstrate their focus on safety as well as provide encouragement to employees to report safety events (QAPI leadership rounding guide, n.d.).  Additionally, it is crucial that healthcare workers continue to assess the data in order to avoid complacency and to move toward continued improvement (The essential role of leadership in developing a safety culture, 2017).

Transparency
Further, literature discusses the benefits of transparency (Creating and sustaining a culture of safety, 2004). In order for a widespread culture of safety, departments must be transparent regarding safety occurrences and initiatives. In conjunction with the previously discussed safety reporting systems, transparency allows for all members of the healthcare team, from frontline staff to executives, to be aware of safety events. Transparency has a two-fold benefit. The initial benefit may seem rather obvious: transparency provides all staff members with information regarding safety events. While it may seem overly simplistic, knowledge of safety events is crucial for all staff members. When armed with knowledge regarding the number and types of safety occurrences, all members of the healthcare team can be aware of potential safety issues and therefore act to reduce safety incidences. Additionally, transparency encourages accountability among all employees related to safety occurrences. When safety data is regularly shared, everyone shares the responsibility of improving safety at the institution (The essential role of leadership in developing a safety culture, 2017). Shared responsibility and accountability go hand-in-hand with the ever-important just culture, as all within the institution share the burden of improving safety rather than pointing fingers at individuals. Along with transparency about the type and number of safety events, transparency also includes sharing information about initiatives made toward improving safety at the institution. Information regarding safety improvement efforts again encourages everyone to be accountable and responsible for implementing improvement initiatives (Creating and sustaining a culture of safety, 2004).

Employee Safety
As advancements in patient safety continue, this goal of a culture of patient safety can be expanded to incorporate employee safety. The Federal Occupational Safety and Health Administration (OSHA) reported a strong relationship between a culture of safety and employees following appropriate infection control precautions, which is a contributor to both patient and employee safety (Organizational Safety Culture-Linking Patient and Worker Safety, n.d.). Along with safer patient care, the literature shows that safer employees have higher morale and therefore create a stronger and more motivated workforce (Barr, Miller, Principe, Merandi, & Catt, 2016). Additionally, safer employees are more cost-effective as they require fewer days off, reduce healthcare costs, and may have fewer turnovers due to their higher morale (Barr, Miller, Principe, Merandi, & Catt, 2016).