1. Culture of Safety John Morley, MD Chief Medical Officer Jacobi Medical Center & North Central Bronx NYC Health & Hospitals

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5. 5 Friday, March 11, 2011 @ 05:46 UTC

7. July 6, 2013 @ 11:28 PDT http://www.ntsb.gov/news/events/Pages/2014_Asiana_BMG-Abstract.aspx

8. http://www.bbc.com/news/uk-england-stoke-staffordshire-20965469

11. So… What do a University scandal, a Tsunami with a Level 7 nuclear accident, a plane crash and hospital scandal all have in common?

12. Culture - A set of common, unspoken and assumed values that drive decision making in an organization or unit.

13. What is Culture? It is NOT - A Mission or a Vision statement A set of ideals or the wishes of the CEO or executive leadership Insignificant 13

14. Culture “Culture” Professors Ken Thompson (DePaul) and Fred Luthans (Nebraska) identify seven characteristics of culture: Culture = Behavior  Culture is defined & determined by values  But not just any values! Culture is Learned Through Interaction Sub-cultures Form Through Rewards People Shape the Culture Culture is Negotiated (priorities are negotiated) Culture is Difficult to Change 14

15. What is Culture? It is Actions!! It is behaviors!! I have always thought the actions of men the best interpreters of their thoughts. — John Locke Well done is better than well said. — Benjamin Franklin Remember, people will judge you by your actions, not your intentions. You may have a heart of gold — but so does a hard- boiled egg. — Author Unknown Ironically, making a statement with words is the least effective method. — Grey Livingston 15

16. What is Culture? We are all inclined to judge ourselves by our ideals; others, by their acts. — Harold Nicolson When deeds speak, words are nothing. — African Proverb I grow older I pay less attention to what men say. I just watch what they do. — Andrew Carnegie People may doubt what you say, but they will believe what you do. — Lewis Cass 16

17. http://media.pennlive.com/midstate_impact/other/REPORT_FINAL_071212.pdf

18. 18 http://usatoday30.usatoday.com/news/nation/story/2012-07-12/louis-freeh-report-penn-state-jerry- sandusky/56181956/1 http:// i.usatoday.net/news/nation/2012-07-12-penn-state-freeh-report.pdf

19. 19 http://www.nirs.org/fukushima/naiic_report.pdf

20. http://www.reuters.com/article/2014/02/10/us-asiana-culture-idUSBREA1906U20140210 20

22. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/2267 03/Berwick_Report.pdf

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24. 24 http://www.youtube.com/watch?v=5CcLIPaUz3E http://www.youtube.com/watch?v=AbFIPc34AJ8 A winning culture at Zappos https://www.youtube.com/watch?v=cQLTQAv5JQA

27. “Safety Culture” First used in INSAG’s (1988) ‘Summary Report on the Post-Accident Review Meeting on the Chernobyl Accident’ where safety culture was described as: “That assembly of characteristics and attitudes in organizations and individuals which establishes that, as an overriding priority, nuclear plant safety issues receive the attention warranted by their significance.” 27

28. 28 http://pbadupws.nrc.gov/docs/ML1208/ML120810464.pdf

29. So what do we know about our culture?

30. 30 http://www.ahrq.gov/professionals/quality-patient- safety/patientsafetyculture/hospital/resources/hospscanform.pdf

31. Areas of Strength for Most Hospitals The four areas with the highest % positive responses: 1.Teamwork Within Units (average 80% positive response) 2.Supervisor/Manager Expectations and Actions Promoting Pt. Safety (average 75% positive response) 3.Organizational Learning—Continuous Improvement (average 72% positive response) 4.Management Support for Patient Safety (average 72% positive response) 31 http://www.ahrq.gov/professionals/quality-patient- safety/patientsafetyculture/hospital/2012/hosp12summ.html

32. Areas With Potential for Improvement for Most Hospitals Three areas showed potential for improvement: 1.Non-punitive Response to Error (average 44% positive response) 2.Handoffs and Transitions (average 45% positive response) 3.Staffing (average 56% positive response) 32

35. What is it that defines YOUR culture?

36. Loyal Honesty Dependable Committed Open minded Committed Transparency Quality Safety Creative Innovative Respect $Revenue$ Courageous Efficient Effective Patient/Family Centered Effective Equitable Timely Values Consistent/ HRO Compassion Speaking up

37. Dependable Revenue Loyal Quality Committed Open-minded Consistent Honest Efficient Innovative Creative Humorous Fun-loving Motivated Honesty Transparency Positive Honesty Optimistic Inspiring Passionate Respectful Athletic Fit Courageous Educated Respected Loving Nurturing Adventurous Mt. Saint Everywhere General Safe, Effective, Efficient, Timely, Family Centered and Equitable

38. 1.Revenue 2.Dependable 3.Loyal 4.Committed 5.Open-minded 6.Consistent 7.Honest 8.Efficient 9.Innovative 10.Creative 11.Humorous 12.Fun-loving 13.Motivated 14.Honest 15.Positive 16.Optimistic 17.Inspiring 18.Passionate 19.Respectful 20.Athletic 21.Healthy employees 22.Courageous 23.Educated 24.Respected 25.Loving 26.Nurturing 27.Adventurous 28.Transparency 29.Quality 30.Safety

39. 1.Football 2.Revenue 3.Football 4.Committed 5.Open-minded 6.Academics 7.Football 8.Efficient 9.Innovative 10.Football 11.Honest 12.Fun-loving 13.Motivated 14.Football 15.Positive 16.Optimistic 17.Inspiring 18.Passionate about football 19.Respectful 20.Athletic 21.Healthy employees 22.Courageous 23.Educated 24.Respected 25.Loving 26.Nurturing 27.Adventurous 28.Transparency 29.Quality 30.Safety Penn State Protection of children

40. 1.Safety 2.Quality 3.Transparency 4.Speaking up 5.Dependable 6.Reliable 7.Loyal 8.Committed 9.Open-minded 10.Consistent 11.Honest 12.Efficient 13.Innovative 14.Creative 15.Humorous 16.Fun-loving 17.Motivated 18.Honest 19.Positive 20.Optimistic 21.Inspiring 22.Passionate 23.Respectful 24.Healthy employees 25.Courageous 26.Educated 27.Respected 28.Loving 29.Nurturing 30.Adventurous Your hospital

41. 41 http://www.nejm.org/doi/pdf/10.1056/NEJMp0801863

42. 42 http://onlinelibrary.wiley.com/doi/10.1002/jhm.2092/abstract

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45. High Reliability Organizations This mindset is supported by five characteristic ways of thinking: preoccupation with failure reluctance to simplify explanations for operations, successes, and failures sensitivity to operations (situation awareness) deference to frontline expertise commitment to resilience

47. https://psnet.ahrq.gov/primers/primer/31

48. 1.Safety 2.Quality 3.Transparency 4.Dependable 5.Reliable 6.Loyal 7.Committed 8.Open-minded 9.Consistent 10.Honest 11.Efficient 12.Innovative 13.Creative 14.Humorous 15.Fun-loving 16.Motivated 17.Honest 18.Positive 19.Optimistic 20.Inspiring 21.Passionate 22.Respectful 23.Athletic 24.Healthy employees 25.Courageous 26.Educated 27.Respected 28.Loving 29.Nurturing 30.Adventurous Your hospital

49. In the beginning was the Plan... In the beginning was the Plan. And then came the Assumptions. And the Assumptions were without form. And the Plan was without substance. And darkness was upon the face of the Workers. And the Workers spoke among themselves, saying, "This is a crock…and it stinks." And the Workers went unto their Supervisors and said, "It is a pail of dung, and we can't live with the smell." 49

50. In the beginning was the Plan... And the Supervisors went unto their Managers, saying, "It is a container of excrement, and it is very strong, such that none may abide by it.“ And the Managers went unto their Directors, saying, "It is a vessel of fertilizer, and none may abide its strength." And the Directors spoke among themselves, saying to one another, "It contains that which aids plant growth, and it is very strong." And the Directors went to the Vice Presidents, saying unto them, "It promotes growth, and it is very powerful." 50

51. In the beginning was the Plan... And the Vice Presidents went to the President, saying unto him, "This new plan will actively promote the growth and vigor of the company with very powerful effects." And the President looked upon the Plan and saw that it was good. And the Plan became Policy. And that, my friends, is how …it Happens. 51

52. Culture of Safety Even if you are not defining the institutional culture, you are part of a unit and a shift and you are a part of defining that culture. The only way to know your culture is to be a part of it. Get out there and lead. Be a part of making your culture a Culture of Safety or even better a HRO

54. If I have seen further it is by standing on ye shoulders of Giants. — Sir Isaac Newton 54