Culture as part of a spectrum From the SafeCare BC Workplace Health and Safety Culture Framework

The Safety Culture Framework Purpose: To help understand safety culture as a multi-dimensional concept To show what varying levels of cultural maturity look like To assist in self-reflection and encourage discussion about the strengths and weaknesses in staff safety culture To provide a starting point for the development, implementation and assessment of continuous improvement initiatives Broken down into 11 different dimensions of safety culture, which can each be described along the spectrum (pathological → generative) What its NOT: A performance management or disciplinary tool A way of assigning blame

Why do we need to waste our time on staff safety? We take staff safety seriously and do something when we have an incident. We have all systems in place to manage staff safety. We are always on alert, considering staff safety issues that might emerge. Managing staff safety is an integral part of everything we do. From the SafeCare BC Workplace Health and Safety Culture Framework PathologicalReactiveCalculativeProactiveGenerative

1.Commitment to Prevention & Continuous Improvement Key Indicators for this Dimension: How committed to prevention and continuous improvement is the care site? What is the approach taken to system audit tools (e.g. safety audits)? How are policies and procedures developed and implemented? Is staff input and consultation incorporated into health and safety measures?

PathologicalReactiveCalculativeProactiveGenerative Little commitment to prevention Few analysis tools are utilized Policies and procedures rarely put into practice Analysis tools used for major incidents only, with few improvements implemented Policies and procedures designed to stop major incidents from reoccurring, but often ignored when they are competing demands Prevention motivated by desire for recognition Tools used mechanically by management Policies and procedures are rarely implemented and lack staff input Culture of prevention and improvement Robust policies & procedures Teams responsible for analysis tools Staff input incorporated in all safety measures Significant efforts for proactive & preventative measures Tools used frequently by all staff Policies and Procedures are based on best practice and revised based on effectiveness 1.Commitment to Prevention & Continuous Improvement

2. Priority Given to Staff Safety Key Indicators for this Dimension: How seriously is the issue of staff safety taken within the organization? What is the role of risk management systems? Where does the responsibility lie for staff safety? How much weight is given to financial considerations?

2. Priority Given to Staff Safety PathologicalReactiveCalculativeProactiveGenerative Low priority Few systems in place No clear line of responsibility $$ are most important Prioritized following an incident Little active prevention Reporting discouraged Financial incentive to enhances staff safety High priority but preventative measures are inflexible Responsibility designated to one individual Cost & Safety are “juggled” Safety is an ethical imperative Everyone is responsible Cost and Safety are balanced Highly prioritized with active participation encouraged One delegated lead and included in all portfolios Safety is seen as cost saving

3. Perceptions of Safety Incidents Key Indicators for this Dimension: Are staff safety incidents viewed as unavoidable or preventable? Who/ What are perceived as being responsible for staff safety incidents? What reporting systems are in place? How is reporting of incidences perceived and received?

PathologicalReactiveCalculativeProactiveGenerative Staff incidents are unavoidable Only the staff person is responsible Reporting is ad-hoc & discouraged Strong blame culture Incidents are the result of “bad- luck” or “bad apples” Reporting system exists, but reporting is not encouraged Blame culture exists Incidents result from a range of factors, not just staff Anonymous reporting system exists (forms forms forms!) Feelings of vulnerability persist Always looking for root causes of incidents Reporting of incidents & near misses encouraged Culture of trust & transparency A range of potential factors may cause incidents Reporting methods are user friendly, and reporting is encouraged Staff feel safe 3. Perceptions of Safety Incidents

Key Indicators for this Dimension: Who investigates incidents and how are they investigated? What is the aim of the organization? Does the organization learn from the event? 4. Investigating Staff Safety Incidents

PathologicalReactiveCalculativeProactiveGenerative Superficial investigation by junior manager Goal is to assign blame Outcomes of investigation are not shared No organizational learning Damage Control Investigation is tokenistic and focused on immediate causes Band Aid solutions proposed Little follow up Investigation by senior management, but is cumbersome No root cause identified Existing policies and procedures are reviewed as follow up Investigations identify root causes are result in continuous organizational learning Everyone is involved and feels safe and supported Everyone involved in incident is involved in investigation Root cause and gaps are identified Information shared and used for organizational learning 4. Investigating Staff Safety Incidents

Key Indicators for this Dimension: What happens after an incident? What mechanisms are in place to learn from the incident? How are changes introduced, communicated and evaluated? 5. Organizational Learning

PathologicalReactiveCalculativeProactiveGenerative No changes are made following incidents Little information in shared Similar incidents reoccur Significant events are investigated Information is linked to specific incidents Top down changes have little staff buy in Reported incidents are investigated But information is only shared within each team Top down changes have little staff buy in Incidents both external and internal are learned from Information is shared to create a dialogue Changes are self enforced All incidents & near misses are investigated, with root cause identified Information is shared with everyone Changes are sustainable because staff is engaged and included in process 5. Organizational Learning

Key Indicators for this Dimension: Is health and safety information shared with staff? Are staff consulted or engaged before changes are made to health and safety practices or procedures? Are there systems in place for staff to share their insights with management? 6. Communication & Consultation

PathologicalReactiveCalculativeProactiveGenerative Communication is poor & safety information is not shared with staff Staff insights into safety are not shared upwards with management Only serious incidents trigger upwards communications H&S information shared only with those directly involved Lack of staff consultation means chances are not sustainable Safety information is available, but few staff insights are shared upwards Health and safety initiatives are frequent, but there is little staff consultation, & changes are not sustainable Strong commitment to open communication, and staff insights are highly valued Innovative ideas are praised Changes are sustainable Systems are in place and monitored for effectiveness Information is shared in both directions and staff consultation is frequent Communication strategies are flexible 6. Communication & Consultation

Key Indicators for this Dimension: How are health and safety issues incorporated into staff recruitment and retention? What is the organizational approach and attitude towards staff’s health, safety and well-being? What resources are provided to staff to enable them to model health and safety in the workplace, as well as to engage in continuous improvement? 7. Staff and Safety Issues

PathologicalReactiveCalculativeProactiveGenerative Personnel policies make no reference to health and safety Resources are inadequate to work safely No genuine concern for staff health and safety Basic human resources policies exist with some focus on retention and selection, but were developed in response to previous incidents Staff receive limited organizational support Staff recruitment and retention policies exist, but are paper work heavy Performance appraisals exist, but are not used for continuous improvement Organization incorporates personal management into daily operations Staff well-being is an organizational commitment Genuine concern for staff health and safety All resources needed to work safely are provide Staff retention policies promote improvement, and are not “one size fits all” 7. Staff and Safety Issues

Key Indicators for this Dimension: Is staff education and training a priority? How, why and when are education and training programs offered to staff? What do staff think of them? Are staff actively engaged or mandated to receive trainings? 8. Safety Learning & Education

PathologicalReactiveCalculativeProactiveGenerative Staff receive only mandatory training (low- priority) Training is viewed as costly Training is not evaluated for effectiveness Training occurs only following serious incidents Little guidance is provided for new staff Financial resources for training are limited Standard training occurs regularly, but isn’t always relevant Training fulfills organizational need Educating and Learning are an ongoing process Staff are actively involved in personal development, including OH&S training Staff education and training is highly valued, well-funded and planned Staff may identify their own training needs Training fulfills both organizational need and staff’s personal development 8. Safety Learning & Education

Key Indicators for this Dimension: How and when are teams developed? How are teams managed and are they effective? Are ideas, innovations and information able to be communicated within teams? 9. Teamwork & Collaboration

PathologicalReactiveCalculativeProactiveGenerative Staff work in isolation Teams are inefficient & hierarchical Communication often breaks down Teams exists, but lack the appropriate supports to work together effectively Teams are still hierarchical Teams form only in response to staff safety incidents Team work is stated to be important, but this isn’t reflected in practice Teams lack cohesion Communication is basic, but innovations aren’t shared Teams are fluid, flexible & high functioning Share a common vision Communication is strong Team exists, and are fluid with flattened hierarchies Team members may include people from outside organizations or agencies Innovations and Ideas are shared freely 9. Teamwork & Collaboration

Key Indicators for this Dimension: How and why are leaders provided with health and safety training & education? How do leaders use their training to promote and motivate safe work practices among staff? How, when and why is health and safety performance incorporated into leaders performance evaluations? 10. Leadership Commitment

PathologicalReactiveCalculativeProactiveGenerative Leaders receive no staff safety training & are ineffective at promoting safe work practices Performance reviews do not reflect staff OH&S Leaders provided with basic OH&S info only (policies, procedures, etc.) Staff safety promotion incorporated into job description, but only evaluated following significant incidents Leaders receive knowledge based training Training is focused around reducing staff incidents Evaluated on outcomes only All leaders receive OH&S training based guided by their performance evaluations based on leading indicators Peer-to-Peer feedback is routine and valued Leaders receive skills-based training to improve skills & promote staff safe work practices Leaders are evaluated regularly, and focus is on process rather than outcome 10. Leadership Commitment

Key Indicators for this Dimension: What approach does the organization take to staff workload management? What tools are in place to prevent and reduce fatigue? What factors are seen as contributing to staff fatigue? How is staff fatigue perceived to be related to OH&S and staff retention? 11. Workload Management

PathologicalReactiveCalculativeProactiveGenerative No consideration for workload management Fatigue is part of the job “We do more with less” Staff turnover is high Resident to Staff ratios are used haphazardly Fatigue is recognized to contribute to safety incidents Hours per shift are limited to reduce fatigue Resident to Staff ratios are used according to best practice Attempts are made to manage fatigue through scheduling, BUT other contributing factors are overlooked Holistic approach to managing staff workload Organization & Staff are guided by the ethical obligation to maintain “fitness to practice” Scheduling takes resident acuity and staff composition into account Staff encourage to full recover between shifts, and take breaks during All staff educated to recognize fatigue Healthy lifestyle promoted for all staff 11. Workload Management