When the Institute of Medicine (IOM) chronicled an alarming trend of preventable medical errors plaguing the U.S. healthcare system, The Joint Commission responded by implementing national patient safety goals (NPSGs).
The Commission, a nonprofit group that accredits nearly 21,000 healthcare organizations and programs nationwide, said strong leadership is an essential component of developing a culture of safety. Among those professionals who are leading safety initiatives and creating a culture of safety are advanced practice registered nurses (APRNs). These APRNs include those who have earned Doctor of Nursing Practice (DNP) degrees and are working as healthcare leaders.
DNP-prepared nurses can develop and lead initiatives in clinical quality and safety culture to better implement national patient safety goals. Anyone aspiring to the next stage of their nursing career should be familiar with how a culture of safety in nursing can affect patient safety goals, as well as the know-how to identify ways to improve that culture.
Patient Safety Outcomes
The Joint Commission established its NPSG program in 2002 to address specific areas of patient safety outcomes. In 2008, the organization introduced the idea of establishing and applying a culture of safety to its national patient safety goals. This concept of a culture of safety first originated in the nuclear energy and aviation industries.
In specifically addressing the roles that leaders play in patient safety, the Commission found several ways that inadequate leadership contributes to adverse healthcare events and patient outcomes.
Inadequate Support of Patient Safety Event Reporting
Patient safety event reporting systems are a mainstay of hospitals and other healthcare organizations to identify safety incidents. A key component of safety event reporting is having a supportive environment that protects the privacy of staff members who are doing the reporting. If a staff member is fearful of possible reprisals, they may hold back on reporting, potentially putting future patients at risk.
Lack of Feedback to Those Who Reported Safety Vulnerabilities
Health professionals have cited a failure to receive feedback after reporting adverse safety events as a barrier to reporting future events. Feeling either unheard or ignored, these professionals are discouraged from taking important action for the sake of greater safety.
Allowing Intimidation of Staff Members Who Report Adverse Events
Intimidation of staff members who report safety incidents may manifest itself in many forms, from a simple eye roll to something more severe such as being directly threatened. If someone feels stonewalled by an intimidating or unreceptive response, it can shut down communication and create situations where safety can be compromised.
Refusing to Consistently Prioritize Safety Recommendations
Leaders at all levels of healthcare management must implement and maintain a culture of safety in ways that consistently demonstrate, support, and promote safety measures. This should include a deliberate, research-oriented approach to constantly updating and improving upon safety procedures.
Not Recognizing or Addressing Staff Burnout
Clinical burnout, or emotional exhaustion, is linked to a clinician’s inability to maintain safety practices and detect safety threats. A 2019 study of employee engagement in nursing found that 85% of nurses reported work-related fatigue, 44% feared that patient care could suffer as a result, 37% worried about making a mistake and 11% reported they have made a mistake because of being overtired.
10 Patient Safety Goals
The Joint Commission recommends leaders focus on five components of safety culture: trust, accountability, identifying unsafe conditions, strengthening systems, and assessment.
The Commission also outlined actions that healthcare organizations should implement to create and sustain an atmosphere that encourages a culture of safety.
- Create a transparent, non-punitive approach to reporting adverse events, close calls, and unsafe conditions.
- Establish a transparent and just process for recognizing human error, errors based on poorly designed systems, and errors based on reckless actions.
- Encourage all leaders to model appropriate safety behaviors and champion efforts to eradicate the intimidation of employees who report safety incidents.
- Communicate policies that encourage and enforce a safety culture and the reporting of adverse events, close calls, and unsafe conditions.
- Provide positive recognition for staff members who identify or report adverse events, close calls, and unsafe conditions.
- Utilize safety culture performance assessments and surveys, such as the AHRQ’s Hospital Survey on Patient Safety Culture (HSOPS), for a deeper understanding of the organization’s safety culture and unwritten rules.
- Develop quality and safety improvements based on assessment and survey outcomes.
- Establish a safety culture quality team to organize and implement safety systems.
- Encourage staff to ask questions and clarify uncertainties without fear of intimidation or rejection.
- Repeat organizational safety culture assessments every 18 to 24 months for an open-ended review of patient safety goals.
DNP-educated APRNs and Patient Safety Goals
In the years since the Institute of Medicine (IOM) published its groundbreaking report titled “To Err is Human: Building a Safer Health System” and released subsequent reports, APRNs have been heralded as major contributors to creating better national patient safety goals and strong safety cultures.
Linda Paradiso, DNP, said a nurse leader’s response to safety concerns is crucial to building a stable system where nurses feel safe expressing concerns. Without this sense of stability and safety, nurses may be encouraged to keep their observations to themselves, which can create a risky situation for caregivers, patients, and others.
“Nurses who trust their supervisors to listen, support and console when they make human errors or risky choices will be more likely to escalate patient safety issues and speak up when participating in process improvement,” Paradiso said in the article “Everyone Is Responsible for a Culture of Safety,” published in the journal American Nurse.
Indeed, nurse leaders are prepared to take on roles in patient safety and safety culture. Nurses prepared at the DNP level use evidence-based information to create a culture of safety in healthcare organizations. As a practice-based terminal degree, the DNP provides an opportunity for APRNs to apply sound research to everyday work.
Accelerate Your Nursing Education
Duquesne University’s online DNP program prepares graduates to spearhead institutional changes. The goal is to create a culture that aligns with national patient safety goals. The Duquesne DNP curriculum builds on knowledge and experience in nursing and safety, leading to a comprehensive education that is focused on developing innovation.
The 100% online DNP program allows APRNs to work toward an advanced degree while continuing their career and family responsibilities. With courses such as Social Justice and Vulnerable Populations, Transcultural Care and Global Health Perspectives, and Clinical Prevention and Population-Based Health Promotion, the Duquesne DNP curriculum offers students expertise at the leading edge of the field.
Find out how to jumpstart your career today — with a degree from Duquesne.
Recommended Readings
How to Achieve Your Long-Term Nursing Goals
Six Tips for Success as a Nurse Manager
Nursing Career Paths and Advancement Guide
Sources:
Agency for Healthcare Research and Quality, “Reporting Safety Patient Events”
American Nurse, “Everyone Is Responsible for a Culture of Safety”
The Joint Commission, Pain Assessment and Management Standards
The Joint Commission, Sentinel Event Alert 57
Kronos, Healthcare: Wake Up to the Facts About Fatigue
Patient Safety Network, Reporting Patient Safety Events