Implementing a High Reliability Safety Culture Cycle to Improve Patient Safety Outcomes

In 2001, the Institute of Medicine challenged healthcare organizations to improve practice models to increase patient safety and quality care. Despite this challenge and the many safety regulations in place, patient safety continues to be a serious concern. Currently, on an Acute Care for the Elderly unit, elements of a culture of safety exist, although there is no formal process for identifying and addressing potential problems or reviewing, sharing, and learning from adverse events. The PICOT question is: On an inpatient geriatric unit, will the implementation of a High Reliability Safety Culture Cycle result in a reduction in hospital acquired conditions, adverse patient events, length of stay, improved patient/family satisfaction and increased staff perception of safety culture compared with the current lack of an intentional safety culture over a twelve-month period? The objective of this evidence-based change in practice is to reduce patient harm and improve safety outcomes for geriatric inpatients. A High Reliability Safety Culture Cycle, an evidence-based approach to establishing and maintaining a culture of safety, will be implemented. This approached is based on the High Reliability Organization Theory, consisting of five components: 1) preoccupation with failure, 2) a reluctance to simplify, 3) sensitivity to operations, 4) a commitment to resilience, and 5) a deference to expertise. The Safety Culture Cycle is comprised of six phases: (a) shift safety briefing, (b) interdisciplinary rounds, (c) post-event debrief, (d) event reporting, (e) event investigation, and (f) findings shared with staff. The components of the High Reliability Safety Culture Cycle are implemented sequentially and cyclically. All phases are nurse-led and conducted in a collaborative manner with the support of leadership. The cycle addresses the fact that despite all best efforts, adverse events can still occur. Kotter and Cohen’s Change Theory will guide implementation while outcomes will be measured through event reports, electronic medical record reports, Press Ganey surveys, and Safety Culture Surveys.