An Interdisciplinary Approach to Creating a Culture of Safety

Abstract

Poster Presentation Purpose for the Program At New York Presbyterian Weill Cornell Medical Center, potentially unsafe behaviors or conditions have been observed on the labor and delivery unit. We demonstrate the successful implementation of an innovative program to improve the culture of safety within the obstetric unit with a goal to improve outcomes. Proposed Change To use TeamSTEPPS as a basis and transform a less safe working environment into a safer, more collaborative, working environment. Implementation, Outcomes, and Evaluation A formalized plan for a culture of safety was gradually introduced to the obstetric department. Before the initial culture of safety roll out, an Agency for Healthcare Research & Quality (AHRQ) survey was completed by staff members. Formalized TeamSTEPPS training set the framework for communication tools and modalities that would be the expectation in all obstetric areas. Eighty‐five percent (450 members) of the obstetric team completed TeamSTEPPS training by September 2014. Once staff had an understanding of the plan, leadership from nursing, obstetrics, and anesthesia were able to promote the use of tools, including multidisciplinary briefs, huddles, and debriefs, which created a general, nonpunitive, transparent department. This is demonstrated by a 45% increase in medical event reporting across all specialties from January 2013 to August 2014. Evaluation Metrics: Over a 2‐year interval, increases were noted in the following domains of a Culture of Safety survey: (a) When patient safety issues or events were identified and reported to leadership, staff response indicated a 6% increase in feeling that their issues were heard; (b) When patient safety issues or events were identified and reported to leadership, staff response indicates a 14% increase in feeling that action was taken to address the event; (c) When patient safety issues or events were identified and reported to leadership, staff response indicated a 13% increase in feeling the action taken/planned in response prevented future harm or similar events from occurring; (d) When patient safety issues or events were identified and reported to leadership, staff response indicated a 17% increase in feeling that feedback and communication are given about the event. Implications for Nursing Practice Adapting a transparent environment grants nurses the ability to discuss obstetric events and near misses rather than fear retaliation from reporting. The integration of a formal culture of safety program laid the roadmap for everyone to follow, set expectations, and generally changed the way members of the department interacted with one another.