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How Creating a Culture of Trust Keeps Patients Safe

Preventable medical errors are the third-leading cause of death in the United States. Many hospitals and other healthcare facilities unknowingly allow these incidents to flourish by creating a culture where employees, especially clinical nurses, don’t speak up when mistakes happen.

A recent study published in Nursing Management looked at the importance of establishing a just culture and found that nurses in leadership positions usually feel their workplace is more trustworthy than those in lower roles. According to the authors, this then creates “perceptions of unfair treatment and blame,” which can lead to “a possible reluctance among clinical nurses to report, or worse, hide events.”

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What causes a culture lacking in trust?

The researchers outlined specific actions that contribute to this disheartening type of environment:

  • Whenever a mistake occurs, individual nurses or the whole nursing staff attend a retraining program for the relevant procedure, which feels punitive.
  • Administrators fail to address the design or structure of the system that leads errors, which is often the real source of the mistake.
  • Superiors don’t act on clinical nurses’ suggestions for improvement, which makes them reluctant to voice concerns about risky behaviors for patient care.
  • Clinical nurses aren’t included in the processes for analyzing medical errors.

According to the study, eliminating these protocols and behaviors from the hospital system will create a culture of open communication — “the foundation of a reliable organization in which safety events serve as an opportunity to learn, rather than to hold an individual accountable,” the authors write.

Important to note, though, is that a just-culture isn’t necessarily blame-free. Rather, it prioritizes “balanced accountability … Nurse leaders need to look beyond the error to the systems in which clinical nurses work and the behavioral choices they make within those systems.”

How can clinical leaders and administrators build trust among staff?

The authors also offer concrete tips for responding to medical errors in order to encourage communication, especially reporting.

  • Include everyone involved in the incident in the initial investigation and every member of the interdisciplinary team in the debriefing. This helps people understand why they made a choice that led to an error and calls attention to opportunities for system redesign.
  • Only retrain or educate the person who made the mistake when it’s clear the mistake was caused by a lack of training rather than a risky choice prompted by a systemic issue.
  • Acknowledge and manage workplace stress, often caused by chronic understaffing, supply shortages and technology failure. Make the tools team members need to do their jobs well easily accessible.
  • Use an objective algorithm when investigating actual and potential incidents. This instills trust and reinforces the value of identifying errors.
  • Stress the importance of a partnership between clinical nurses and the rest of the organization on the path to improving patient safety. (Nurses at Magnet-recognized hospitals are more likely to report errors because they feel respected and valued.)
  • Recognize nurses who are leading their team in accountability and behaviors that improve patient outcomes.

RELATED: How Great Nurses Teach Physicians to Be More Courteous and Engaged

These changes don’t happen overnight, but implementing these policies and talking to colleagues about creating a culture of trust is a crucial first step. Ultimately, it keeps staff feeling satisfied and patients safe.

Just Culture: It’s More Than Policy, Nursing Management.

Last updated 10/8/19.

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