Culture, Safety, and Value

SUSAN CARR
Editor, susan.psqh@gmail.com

Workplace culture—employees’ attitudes toward each other and the work itself, as well as the mission and values of the organization—affects all aspects of performance, including safety for employees, customers, and the community. In healthcare, a culture of safety is a subset of workplace culture and refers to an environment in which all workers feel comfortable admitting and reporting mistakes, communicating openly with colleagues at all levels, and working proactively to help each other prevent harm to patients.

Workplace culture and its effect on safety was the principal theme of the National Patient Safety Foundation (NPSF) annual Patient Safety Congress held this spring in Austin, Texas. For many years, NPSF has sponsored programs on safety culture. Recognizing that those who are responsible for keeping patients safe must also feel safe themselves, NPSF expanded its work on culture to include the healthcare workplace. In 2013, through its Lucian Leape Institute (LLI), NPSF studied workplace culture and published Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Healthcare.

NPSF’s Congress program offered two keynote sessions focused on workplace culture. In the LLI keynote, Gerald Hickson, MD, of Vanderbilt University Medical Center, and Gary Kaplan, MD, of Virginia Mason Medical Center (and newly announced chair of the LLI), discussed the role of respect in the workplace. Respect for all co-workers and for processes that have been established to foster reliability is a fundamental underpinning of efforts to improve patient safety.

In the final keynote, Allan Frankel, MD, explored the effect of employee motivation on workplace culture, patient safety and value. Through training and consulting, Frankel helps healthcare organizations across the world improve the safety and reliability of care. He finds that he’s able very quickly to sense the culture of care units he visits. As if guided by intuition, he says, “I pretty much can tell if a place is special from the minute I arrive.”

An endoscopy unit at St Francis Health in Indianapolis impressed Frankel in this way with its exceptionally positive and successful workplace culture. In a video clip, a nurse describes having internalized the improvement work she learned on the unit. Laughing, she says she finds herself applying the same principles at home and talking with her mother about Kaizens. She acknowledges that effectiveness, throughput, and cost are goals of improvement, but she and her co-workers are motivated by something else, by wanting to help patients and make care safer for all. Remarkably, she describes what doing the work feels like by saying, “This is your freedom, this is your empowerment; run with it.” She credits her management team for supporting the culture that achieves success for all, including patients, workers, and business interests.

Frankel observes that operational excellence of the kind he sees in the endoscopy suite “is a function of trust, respect, and learning.” Those features provide a special place to work, improve the safety and reliability of care, and deliver better value. When the workplace culture helps people feel good about themselves, they do their best work and create value for patients and the organization that money can’t buy.

Healthcare organizations in the United States know they must provide more value for the country’s financial investment. In this environment, Frankel’s discovery that providing a place where workers say (in Frankel’s words), “I wouldn’t think of working anywhere else because there’s nowhere else that would make me feel as good about myself as I do when I work here,” should renew everyone’s commitment to workplace culture.