|What Do We Mean By a Culture of Safety?
In a culture of safety the focus is on effective systems and teamwork to accomplish the mutual goal of safe, high-quality performance. When something goes wrong, the focus is on what, rather than who, is the problem. The intent is to bring process failures and system issues to light, and to solve them in a non-biased non-threatening way.
The Center for Disease Control (CDC) has defined a culture of safety as the shared commitment of management and employees to ensure the safety of the work environment. The safety of patients and employees is paramount.
A culture of safety acknowledges the inevitability of error, and proactively seeks to identify latent threats. Characteristics of such a culture include:
- Environment where individuals are confident that they can report errors or close calls (“near-misses”) without fear of retribution
- Collaboration across ranks to seek solutions to system vulnerabilities
- Demonstrated willingness to direct resources to address safety concerns
An organization with a culture of safety encourages acknowledgement of error and actively attributes such primarily to process/system failures. Lessons learned from analysis of errors are shared as the best known methods to mitigate or prevent future errors.
The aviation industry faced a number of accidents in the 1970s which were the result of human error. In response to these, and to avoid direct governmental intervention and oversight, the industry set about creating standards and training to eliminate the potential for human error. This was achieved through cross training, double check/redundant verification, and flattened hierarchy.
By acknowledging that errors were ever-present and had catastrophic results, industry leaders were able to get buy-in from cockpit crews (also avoiding conflict with the overseeing unions). This buy-in was essential, as the processes that were implemented required flight crews to strictly follow checklists and double-check one another’s work. A flatter command structure made cross checking one another’s work palatable and resulted in an empowerment of the crew members and expanded the communication between team members.
In 70% of the airline accidents studied, someone in the cockpit knew there was a problem, and was unable to find a way to communicate it. With a flattening of hierarchy, communication flowed more freely despite rank/position and, as it was common to double-check the other team member’s work, there was no stigma associated with noting a discrepancy. Increased communication and cross checking improved safety and, along with similar changes in the ground crew and maintenance teams, made the airline industry one of the safest of the high risk industries. These results were achieved through intensive repetitive training commonly referred to as “Crew Resource Training”.
There are many parallels between the airline industry and that of a medical environment. When thinking of the hierarchy of an aviation team, what parallels can you think of for a medical team working together under similarly high-pressure dynamics? What do you think can be learned from the airlines choice of aspects to change?