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6 tips to boost your safety culture

Publish Date: 9/5/2012

Growing a strong safety culture takes time and your work is never done. But, the hard work is worth it when you see perioperative team members working together in a system that supports a safe patient experience, stresses safety culture champion Charlotte Guglielmi, BSN, RN, MA, CNOR, perioperative nurse specialist at Beth Israel Deaconess Medical Center (BIDMC) in Boston.

BIDMC has been on an institution-wide journey to sustain a culture of safety for over a decade. Still, they face barriers and patient safety errors, including a very public wrong site surgery in 2008.

"You have to use every experience, good and bad, as an opportunity to learn and make things better. This requires a glass-is-half-full attitude, even on rough days," Guglielmi advises.

Here are her tips for reinvigorating a stagnant safety culture:

1: Be patient
"Don't try to solve world hunger by taking on every issue at once, instead take a systematic approach and take the time to really understand your culture," Guglielmi advises. 

"It won't happen overnight, and you'll most likely have a lot of kettles on the stove as you face different issues, especially in today's health care climate," she says. "The key is to stay focused as a team."

2: Understand the system
"Today we know that high reliability organizations have systems in place to support safety. We continually work to refine these systems. Every team member must have a voice and standardized tools," Guglielmi explains.

She suggests that change be implemented thoughtfully, testing solutions and implementing changes in a consistent way to ensure they work.

3: Listen

"You have to listen to what is going on where care is being provided and then share what you hear if you are going to understand the root cause of a safety issue," Guglielmi stresses.

Several different safety groups involving senior leadership, physicians and point of care staff have been shaped at BIDMC and meet on a regular basis.

"Every safety meeting starts with one question: what have you heard?" she notes. "This keeps all of us asking questions, listening to discussion and trying to get to the root of an issue."

4: Be preoccupied with failure
"You can't for a minute forget to stay vigilant and be thinking about where errors might have the possibility of occurring," Guglielmi insists.

"Take the time to ask the whys, observe, take field trips within your facility and beyond in efforts to find different perspectives that may support new ideas for solutions and new ways of working together."

5: Be the change you want to see
As a leader, you portray the model of care, whether you are the CNO, perioperative director, manager, educator or RN circulator leading in the room, she suggests.

"We must hold ourselves just as accountable as we hold others accountable and we cannot fail in expecting nothing but the best from our colleagues, we owe it to them."

6: Build your network and use it

Don't be afraid to reach out, Guglielmi advises. She says a week doesn't go by that she isn't reaching out to colleagues across the country to bounce ideas and gather information.

"Without my network I'm just one nurse in Boston trying to get all of these things figured out. We cant be afraid to ask questions."

Additional Resources 

Read AORN's position statement on Creating a Practice Environment of Safety 

Learn more about AORN's Just Culture Tool Kit 


Guidelines for Perioperative Practice


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