DNPs Leading Safety Culture and Advancing National Patient Safety Goals

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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) to promote improvements in patient safety.

Nurse putting on gloves

Today, almost two decades after the IOM’s “To Err Is Human: Building a Safer Health System” report, NPSGs contain dozens of objectives. NPSGs cover everything from hand washing to pain management for all areas of healthcare, including behavioral health and hospital stays.

The commission, a nonprofit group that accredits nearly 21,000 healthcare organizations and programs nationwide, said strong leadership is an essential component to developing a culture of safety. Among those leading safety initiatives and creating a culture of safety are advanced practice registered nurses (APRNs), including those who have earned Doctor of Nursing Practice (DNP) degrees and are working as healthcare leaders.

The commission said healthcare leaders have the primary responsibility of safeguarding patients from harm.

“A leader who is committed to prioritizing and making patient safety visible through everyday actions is a critical part of creating a true culture of safety,” the commission said in a safety alert.

As nurse leaders, APRNs prepared at the DNP level can develop and lead clinical quality and safety culture initiatives to better implement national patient safety goals.

Inadequate Leadership Equals Poor Safety Outcomes

The commission established its NPSG program in 2002 to address specific areas of patient safety. In 2008, the organization introduced the idea of safety culture within its national patient safety goals. The concept originated in the nuclear energy and aviation industries.

In specifically addressing the roles of leaders in patient safety, the commission found several ways inadequate leadership contributes to adverse events, including:

  • 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 the staff members who are doing the reporting, the U.S. Agency for Healthcare Research and Quality (AHRQ) said.

  • Lack of feedback to those who reported safety vulnerabilities

A study of more than 1,600 U.S. hospitals found health professionals cite a failure to receive feedback after adverse event reporting as a barrier to reporting future events.

  • Allowing intimidation of staff members who report adverse events

Ana Pujols McKee, MD, the Joint Commission’s executive vice president and chief medical officer, said intimidation could come in many forms, from an eye roll to not answering someone’s call, and can shut down communication.

“You have to be very firm around someone who is trying to dismiss or intimidate another staff member,” she said.

  • Refusing to consistently prioritize safety recommendations

Leaders on all levels of healthcare management must implement and maintain a safety culture in ways that consistently demonstrate, support and promote safety measures.

  • 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. One study found that four out of five nurses find balancing mind, body and spirit difficult.

Role of Leadership in a Safety Culture

The 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 for an atmosphere that encourages a safety culture:

  • 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 intimidation.
  • 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.
  • 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

Since the IOM’s “To Err is Human: Building a Safer Health System” and subsequent reports, APRNs have been heralded as a means to creating better national patient safety goals and strong safety cultures.

The IOM’s 2010 report, “The Future of Nursing: Leading Change, Advancing Health,” encouraged all nurses to work to the fullest extent of their education and training, including reaching higher levels of practice. In 2011, the Robert Wood Johnson Foundation followed up by announcing, “Nurses are key to improving patient safety.”

Linda Paradiso, DNP, said a nurse leader’s response to safety concerns is crucial to building a stable system where nurses feel safe to express concerns.

“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 “Everyone Is Responsible for a Culture of Safety,” published in American Nurse Today.

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.

About Duquesne University’s Online DNP Program

Duquesne University’s online DNP program prepares graduates to lead safety changes to create a culture that aligns with national patient safety goals. Duquesne’s DNP curriculum builds on existing knowledge and experience for a comprehensive education that is focused on building innovation.

The 100 percent online DNP program allows APRNs to work toward an advanced degree while continuing career and family responsibilities. For more information, visit DU’s online DNP program website.