Episode #149 The Best Work Environment for Patient Safety and Anesthesia Professionals

Hello and welcome back to the Anesthesia Patient Safety Podcast.  My name is Alli Bechtel, and I am your host. Thank you for joining us for another show. Progress towards improving anesthesia patient safety depends on individual anesthesia professionals building and maintaining a strong base of knowledge and technical skills and then remaining vigilant during anesthesia care to keep patients safe. It also depends on effective leadership to foster an organizational culture that is committed to anesthesia patient safety and this is what we are talking about today.

Before we dive into the episode today, we’d like to recognize Preferred Physicians Medical Risk Retention Group, a major corporate supporter of APSF. Preferred Physicians Medical Risk Retention Group has generously provided unrestricted support to further our vision that “no one shall be harmed by anesthesia care”. Thank you, Preferred Physicians Medical Risk Retention Group – we wouldn’t be able to do all that we do without you!”

Our featured article today is from the June 2020 APSF Newsletter. It is, “Effective Leadership and Patient Safety Culture” by Brooke Albright-Trainer and colleagues. To follow along with us, head over to APSF.org and click on the Newsletter heading. Fifth one down is the Newsletter archives. Then scroll down and click on June 2020. From here, scroll down until you get to our featured article today. I will include a link in the show notes as well.

Do you work at an institution with a strong organizational culture dedicated to patient safety? If so, what do the leaders at your organization do to promote and maintain this culture? To kick off the show today, here is the article summary which highlights why this is such an important topic:

“Effective leadership is necessary in medicine to foster an organizational culture that promotes patient safety. By fostering an environment of psychological safety that encourages others to feel safe communicating issues and speaking up with concerns, leaders are able to act decisively and timely to protect patients and employees. Ultimately, leaders who promote a positive organizational climate contribute to higher job satisfaction among employees, decreased burnout, fewer medical errors, and an overall improved culture of safety.”

That sounds like a great place to work for sure. The APSF recognizes that a culture of safety is an anesthesia patient safety priority. In fact, it is the first one on the APSF’s Top 10 list of perioperative patient safety priorities. For the full list, head over to APSF.org and click on the APSF Priorities heading and I will include a link in the show notes, but now it is time to get into the article.

Let’s start by taking a closer look at the role of leaders. Effective leadership is necessary to ensure success in any project or business or healthcare institution. So, what is effective leadership? The authors provide some examples:

Leading by example

Valuing a strong work ethic

Demonstrating a commitment to the mission beyond self-preservation

Have you ever worked with someone who had a clear vision and was able to use that vision to inspire a larger sense of purpose, and then set the tone for the direction of an organization? When this vision is of a positive and cohesive work environment, the outcome is likely trust between all members of the healthcare team and psychological safety for the employees. Don’t worry, we are going to talk more about psychological safety later on the show today, but first let’s talk about safety culture.

We’ll start with a definition. According to the Joint Commission, safety culture is a collection of “beliefs, values, attitudes, perceptions, competencies, and patterns of behavior that determine the organization’s commitment to quality and patient safety.” Developing and maintaining a safety culture is an important step for decreasing and preventing errors and improving patient safety. One way to evaluate the safety culture at an institution is by looking at the willingness of all employees, clinical, non-clinical, new hires or experienced team members, to speak up when they see a threat to patient safety. Leaders are responsible for developing a supportive environment that encourages speaking up so that the whole team can learn from adverse events, close calls or near misses, and unsafe conditions. A transparent and nonpunitive process for reporting is critical to encouraging team members to speak up. This is the first step towards developing a “just culture,” which can help improve a safety culture. In a “just culture,” individual blame is minimized or removed and the focus is placed on the faults in the system that led to the adverse events.

Another step that leaders must take to develop a safety culture is to eradicate intimidating behaviors. Unprofessionalism is a big threat to patient safety. When it is allowed to persist in an organization, it sends a signal that this behavior will be tolerated which may then promote more unprofessional behavior. Leaders are responsible to addressing unprofessional behavior with a fair and transparent process which will likely lead to improved staff satisfaction and retention, enhanced reputation, improved patient safety and risk-management experience, and better work environments.

Team members have an important role to play in the safety culture by identifying unsafe conditions and coming up with ideas for safety improvements and these team members should be recognized and rewarded by those in leadership positions. Leaders may also use the following techniques to assess the system strengths and vulnerabilities while improving the culture of safety:

• Surveys to identify culture gaps
• Teamwork Training
• Executive walk-rounds
• Establishment of unit-based quality and safety teams.

It’s time for another definition. Let’s talk about psychological safety. The authors tell us that psychological safety is the belief one will not be punished for making an error or speaking up. Based on what we just talked about with safety culture, you can see that psychological safety must be present for there to be a safety culture. There is also a relationship between psychological safety and patient safety and burnout. The benefits of psychological safety include:

• Allowing for creativity
• Speaking one’s mind
• Lack of fear for having new, different, or dissonant ideas
• Discussion of work-life balance issues
• Communication about patient safety issues

Leaders are tasked with creating a supportive environment that allows for psychological safety. Effective leaders do this with open lines of communication and appropriate responses to feedback. This may not be easy, but leaders who are able to accept feedback and respond constructively are better suited to recognize problems earlier and be proactive. Without the combination of open lines of communication followed by a constructive response, team members may not speak up due to fear or retaliation or humiliation.

Next up, we are going to talk about the relationship between organizational culture and employee burnout. The culture in an organization can have a positive impact of improved patient safety and quality or a negative impact with increased burnout. Burnout is a syndrome resulting from chronic workplace stress that has not been successfully managed. The conversation around employee burnout has increased significantly in recent years. Historically, discussions related to work-life balance and burnout were not part of organizational culture until the downstream effects of burnout led to loss of productivity, patient access, lower patient safety scores, and increased costs. Organizational culture can have a big impact on physicians and other members of the healthcare team who may feel undervalued and ineffective when there are frequent changes in management, uncertainty in the organization, lack of a strategic plan, and goal incongruence. Turnover may be a metric for effective leadership and organizational culture. An organization with ineffective leadership may have increased numbers of staff with high burnout leading to higher rates of turnover. High turnover is associated with increased costs, recruitment expenses, agency or locum bridging, higher rates of paid time off, and need for additional support services.

Even back in 2020 there was significant data that burnout in health care workers was associated with increased in incidence of medical errors and malpractice. This continues to be true today and the authors tell us that it is in every institution’s best interest to address employee stress and work to successfully manage it. Thus, an organizational culture that prioritizes a healthy work environment for its health care workers is likely to be a place that provides safer patient care.

We have talked about the 1999 Institute of Medicine landmark report, “To err is human: building a safer health system” before on this podcast. This report highlighted that deaths from medical errors was the third leading cause of death in the US behind cancer and heart disease. Since then, quality improvement projects have focused on improved patient safety. Keep in mind that burnout is a threat to patient safety especially since there is a two-fold increase in medical errors when associated with clinician burnout compared to those not associated with burnout. In this 2018 study by Tawfik and colleagues, “Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors,” the authors reported that 55% of the respondents reported experiences symptoms of burnout. If the majority of clinicians have symptoms of burnout and burnout is associated with high rates of medical errors and medical errors are a big threat to patient safety, then it is imperative for effective leaders to take the necessary steps to support health care professionals’ well-being and work to decrease and ultimately prevent burnout. These steps may include implementing monitoring tools such as workplace wellness initiatives and workplace response teams to support an organizational culture that prevents burnout and is able to keep patients and the healthcare professionals working in the organization safe.

So, what are the key attributes of effective leaders? To find out, we hope that you will tune in next week as we continue to conversation on effective leadership and patient safety culture. Here’s a spoiler alert. Key attributes of effective leaders include the following: effective communication, collaboration, experience, and adaptability. We are going to go into much more detail next week so mark your calendars.

If you have any questions or comments from today’s show, please email us at [email protected]. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today.

Did you know that the APSF has a YouTube Channel? That’s right. It is a great resource for conference recaps and practice updates! I will include a link in the show notes and we hope that you will check it out. We hope that you will subscribe to Anesthesia Patient Safety YouTube Channel and share it with your colleagues, friends, and family as we continue to work towards improved patient safety.

Until next time, stay vigilant so that no one shall be harmed by anesthesia care.

© 2023, The Anesthesia Patient Safety Foundation