Culture
ISyE349
Douglas Safety A. Wiegmann, Ph.D.
Department of Industrial and Systems Engineering
University of Wisconsin - Madison
http://www.youtube.com/watch?v=OyYe97kGq
2Q&feature=related
Overview
Background and History
How is safety culture defined?
What are the indicators of an
organizations safety culture?
Measuring Safety Culture
Can safety culture be changed?
Conclusion
Learning Objectives
Define safety culture and safety climate
Explain the difference between retrospective
and prospective assessment of safety culture
as it relates to PRA
Describe the different organizational
indicators of safety culture and give examples
Discuss methods for measuring and changing
safety culture
Safety Culture:
A Brief History
Chernobyl,
1986
International Atomic Energy Agency noted a poor
safety Culture as a factor in the accident.
Safety Culture:
A Brief History
Kings Cross Underground Fire, 1987
31 people died in the Kings Cross fire which broke
out as commuters headed home. Poor safety culture
cited as a factor.
Safety Culture:
A Brief History
Piper Alpha, 1988
Worst ever offshore
petroleum accident, during
which 167 people died and a
billion dollar platform was
destroyed. Poor safety
culture was cited as
contributing to this accident.
Safety Culture:
A Brief History
Continental Express Flight 2574, 1991
NTSB cites in probable cause: the failure of
Continental Express management to establish
a corporate culture that encouraged and
enforced adherence to approved maintenance
and quality control procedures.
Comair Flight 3272, 1997
Comair's poor safety culture
contributed to its failure to establish
and adequately disseminate
unambiguous minimum airspeed
values for flap configurations and for
flight in icing conditions.
Safety Culture:
A Brief History
NTSB, 1997 National Summit on Transportation Safety
Other Accidents
More recent accidents attributed
to poor safety culture
Columbia Space Shuttle Accident
(2003)
BP Texas City Refinery Explosion
(2005)
Hindsight (retrospective) analysis
of other accidents:
Three Mile Island Accident
Challenger Space Shuttle Accident
Titanic Accident
Safety Culture and PRA
Dont wait for an accident to happen to identify
flaws in your safety
Prospective analysis of Safety Culture
Identify problems before accident/incidents happen
Evaluate the risk that your safety culture (or aspects
of it) pose to your organization
Intervene to change safety culture to reduce
risk/probability of adverse events
Safety Culture in Health Care:
An Unofficial History
1993
Fox J. Decision-support systems as safety-critical components:
towards a safety culture for medical informatics . Methods Inf Med.
1993 Nov;32(5):345-8.
Safety Culture in Health Care:
An Unofficial History
2000-2002
Bagian JP, Gosbee JW. Developing a culture of patient safety at the VA.
Ambul Outreach. 2000 Spring;:25-9.
Meaney M. From a culture of blame to a culture of safety--the role of
institutional ethics committees. Bioethics Forum. 2001;17(2):32-42.
Spath P. It's time for a revolution in patient safety culture. Hosp Peer
Rev. 2001 Jun;26(6):85-6, 74.
Helmer GW. Safety culture: sustaining the strategy. Occup Health Saf.
2002 Dec;71(12):14-6, 18.
Mustard LW. The culture of patient safety. JONAS Healthc Law Ethics
Regul. 2002 Dec;4(4):111-5.
Safety Culture in Health Care:
An Unofficial History
2003 - 2004
Hargreaves S. "Weak" safety culture behind errors, says chief medical officer.
BMJ. 2003 Feb 8;326(7384):300.
Wells JW Jr. How effective is your safety culture? Occup Health Saf. 2003
Sep;72(9):26-8, 30.
Nieva VF, Sorra J. Safety culture assessment: a tool for improving patient
safety in healthcare organizations. Qual Saf Health Care. 2003 Dec;12 Suppl
2:ii17-23.
Ruchlin HS, Dubbs NL, Callahan MA. The role of leadership in instilling a culture
of safety: lessons from the literature. J Healthc Manag. 2004 Jan-Feb;49(1):4758; discussion 58-9. Review.
Frankel A, Haraden C. Shuttling toward a safety culture. Healthcare can learn
from probe panel's findings on the Columbia disaster. Mod Healthc. 2004 Jan
5;34(1):21.
Beyea SC. Creating a just safety culture. AORN J. 2004 Feb;79(2):412-4
Mann C. Safety culture? What safety culture? Nurs Manag (Harrow). 2004
Nov;11(7):10-3.
Safety Culture in Health Care:
An Unofficial History
2005-2006 Explosion
Yates GR, Bernd DL, Sayles SM, Stockmeier CA, Burke G, Merti GE. Building and
sustaining a systemwide culture of safety. Jt Comm J Qual Patient Saf. 2005
Dec;31(12):684-9.
Milligan F, Dennis S. Building a safety culture. Nurs Stand. 2005 Nov 2329;20(11):48-52.
Ginsburg L, Norton PG, Casebeer A, Lewis S. An educational intervention to
enhance nurse leaders' perceptions of patient safety culture. Health Serv Res.
2005 Aug;40(4):997-1020.
Pronovost P, Sexton B. Assessing safety culture: guidelines and
recommendations. Qual Saf Health Care. 2005 Aug;14(4):231-3.
Render ML, Hirschhorn L. An irreplaceable safety culture. Crit Care Clin. 2005
Jan;21(1):31-41, viii.
Pinkerton S. Patient safety culture. Health Care Manage Rev. 2005 JanMar;30(1):1.
Fleming M. Patient safety culture measurement and improvement: a "how
to" guide. Healthc Q. 2005;8 Spec No:14-9.
Safety Culture in Health Care:
An Unofficial History
2005-2006 Explosion
Hughes CM, Lapane KL. Nurses' and nursing assistants' perceptions
of patient safety culture in nursing homes. Int J Qual Health Care.
2006 Aug;18(4):281-6. Epub 2006 Jul 19.
Grant MJ, Donaldson AE, Larsen GY. The safety culture in a children's
hospital. J Nurs Care Qual. 2006 Jul-Sep;21(3):223-9.
Milligan FJ. Establishing a culture for patient safety - The role of
education. Nurse Educ Today. 2006 May 17.
Murphy T. CCHSA Client/Patient Safety Culture Assessment
Project: lessons learned. Healthc Q. 2006;9(2):52-4, 2.
Safety Culture in Health Care:
An Unofficial History
2005-2006 Explosion
Assessing Patient Safety Culture:
A Review and Synthesis of the
Measurement Tools.
Journal of Patient Safety. 2(3):105-115,
September 2006.
Singla, Aneesh K. MD, MPH *+; Kitch,
Barrett T. MD, MPH *; Weissman, Joel
S. PhD *++; Campbell, Eric G. PhD *
What is Safety Culture?
(Wiegmann et al., 2002 - Reviewed over 100 articles)
Numerous studies have attempted to assess
safety culture in a variety of domains
There is lack of consistency in definitions
Such terms as safety climate often add to the
confusion
Efforts to study safety culture have remained
unsystematic, fragmented and in particular
under-specified in theoretical terms
Definitions of Safety Culture
There are a variety of definitions of safety culture.
Safety culture is defined as the shared values, beliefs, assumptions, and
norms which may govern organizational decision making, as well as
individual and group attitudes about safety (Ciavarelli&Figlock,1996) .
Safety culture reflects attitudes, beliefs, perceptions, and values that
employees share in relation to safety (Cox & Cox, 1991).
A safety culture exists within an organization where each individual
employee, regardless of their position, assumes an active role in error
prevention and that role is supported by the organization (Eiff &
Lafayette, 1999) .
Safety culture is defined as the attitudes, values, norms and beliefs
which a particular group of people share with respect to risk and safety
(Mearns, Flin, Gordon, & Fleming, 1998) .
Definitions of Safety Culture:
Common Themes
1.
Safety culture is a concept defined at group level or higher, which refers to the
shared values among all the group or organization members.
2.
Safety culture is concerned with formal safety issues in an organization, and
closely related to, but restricted not to, the management and supervisory
systems.
3.
Safety culture emphasizes the contribution from everyone at every level of an
organization.
4.
The safety culture of an organization has an impact on its members behavior at
work.
5.
Safety culture is usually reflected in the contingency between reward system
and safety performance.
6.
Safety culture is reflected in an organizations willingness to develop and learn
from errors, incidents, and accidents.
7.
Safety culture is relatively enduring, stable and resistant to change.
Definitions of Safety Climate
There are also a variety of definitions of safety climate.
Safety Climate refers to the perceived state of safety of a particular place
at a particular time. It is therefore relatively unstable and subject to
change depending on features of the operating environment (Flin, Mearns
& Gordon, 1998).
The procedures and rules governing safety within an organization are a
reflection of its safety climate, which is centered around employees
perceptions of the importance of safety and how it is maintained within
the workplace (BASI, 1996).
Safety climate is defined as the product of employee perception and
attitudes about the current state of safety initiatives at their place of work
(Yule, Flin, & Murdy, 2001).
Safety climate is the surface features of the safety culture discerned from
the workforce's attitudes and perceptions at a given point in time (Flin,
Mearns, O'Connor, & Bryden, 1998) .
Definitions of Safety Climate:
Common Themes
1. Safety climate is a psychological phenomenon,
which is usually defined as the perceptions of the
state of safety at a particular time.
2. Safety climate is closely concerned with intangible
issues such as situational and environmental factors.
3. Safety climate is a temporal phenomenon, a
snapshot of safety culture, relatively unstable and
subject to change.
Our Working Definitions (neutral)
Safety Culture: The enduring value and priority placed on worker and public
safety by everyone in every group at every level of an organization. It refers
to the extent to which individuals and groups will commit to personal
responsibility for safety; act to preserve, enhance and communicate safety
concerns; strive to actively learn, adapt and modify (both individual and
organizational) behavior based on lessons learned from mistakes; and be
rewarded in a manner consistent with these values.
Safety Climate: The temporal state measure of safety culture, subject to
commonalities among individual perceptions of the organization. It is
therefore situationally based, refers to the perceived state of safety at a
particular place at a particular time, is relatively unstable, and subject to
change depending on the features of the current environment or prevailing
conditions.
Safety culture is a matter of degree not existence it can
range from poor to excellent but not present or absent.
Safety Culture:
Four Organizational Indicators
Organizational Commitment to Safety
Leadership Involvement in Safety Activities
Formal Safety Systems
Informal Safety Systems
Organizational Commitment
the extent to which upper level management
identifies safety as a core value or guiding principle
of the organization.
Reflected by upper managements ability to:
Demonstrate an enduring, positive attitude
toward safety --even in times of fiscal austerity
Actively promote and fund safety activities
across all organizational levels
Organizational Commitment?
Quality and Safety
Leadership Involvement
the extent to which both upper- and mid-level
leaders get personally involved in critical
organizational safety activities.
Reflected by:
Presence & contributions to safety seminars &
training
Active oversight of safety critical operations
Ability to stay in touch with the risks
involved in everyday operations
Extent of good communications about safety
issues both up & down organizational hierarchy
Leadership Involvement?
Staff meeting to improve safety
It appears that everyone heard that the
boss was not planning on attending.
Formal Safety System
refers to processes for identifying and addressing both
occupational and process safety hazards.
Reflected by:
Reporting System accessibility, familiarity, and
actual use of the organizations formal safety
reporting program
Feedback and Response Timeliness and
appropriateness of responses to safety issues
and dissemination of safety information to
employees (transparency)
Safety Personnel Perceived effectiveness and
status of persons involved in formal safety roles.
Respect for Safety Personnel?
Quality and Safety
Informal Safety System
refers to the unwritten norms pertaining to safety behavior,
including rewards and punishments for safe and unsafe actions and
the manner in which such rewards and punishments are instituted in a
just and fair manner.
Reflected in employees by:
Accountability The consistency and
appropriateness with which employees are held
accountable for unsafe behavior
Authority Authorization and employee
involvement in safety decision making
Professionalism Peer culture employee group
norms pertaining toe safe and unsafe behavior.
Justice and
Accountability?
Assessing Safety Culture
Variety of Methods
Interviews
Focus Groups
Observations/Ethnography
Surveys/Questionnaires (most common)
Allow broad assessment
Faster validation of initial ideas
We have identified over 1,000 questionnaire items from
previously developed instruments on safety culture
(nuclear power, manufacturing, military aviation, health
care).
Sample survey for Health Care
http://www.ahrq.gov/qual/hospculture/#toolkit
Hospitals
Ambulatory and/or
Outpatient Facilities
Sample survey for Health Care
Table 6-1. Interpretation of Percentile Scores
Percentile Score
Interpretation
10th percentile
T his score represents the lowest scoring hospitals
10% of the hospitals scored the same or lower.
90% of the hospitals scored higher.
25th percentile
T his score represents lower-scoring hospitals
25% of the hospitals scored the same or lower.
75% of the hospitals scored higher.
50th percentile (or median)
This score represents the middle of the distribution of
hospitals
50% of the hospitals scored the same or lower.
50% of the hospitals scored higher.
75th percentile
T his score represents higher-scoring hospitals
75% of the hospitals scored the same or lower.
25% of the hospitals scored higher.
90th percentile
T his score represents the highest scoring hospitals
90% of the hospitals scored the same or lower.
10% of the hospitals scored higher.
Sample survey from Health Care
Can safety culture be changed?
Some say No
Culture guides the activities of groups and organizations at a
subconscious level.
People do not shape their culture; rather their culture shapes
them in often unpredictable and unforeseeable ways.
The fact that one might believe that culture can be intentionally
changed is in itself a reflection of the culture in which he or she
belongs.
Others say Yes
Why cite safety culture as a cause of an accident if it cant be
changed?
Anecdotally, several organizations appear to have intentionally
changed and/or manipulated other aspects of their culture
What does the data say?
Learning Objectives
Define safety culture and safety climate
Explain the difference between retrospective
and prospective assessment of safety culture
as it relates to PRA
Describe the different organizational
indicators of safety culture and give examples
Discuss methods for measuring and changing
safety culture
http://www.youtube.com/watch?v=WZJsxgKT
3u8&feature=endscreen&NR=1
Questions?