Piecemeal initiatives to improve a patient safety culture are inadequate; improving a patient safety culture requires sequential, iterative and simultaneous interventions that:
Recommendations: Patient safety /quality improvement strategy; board monitoring of performance; measurement (organizational and microsystem levels); event reporting and analysis (focus on gaps and feasible recommendations); investments in work climate; patients and care givers included in patient safety and quality improvement; investments in patient safety /quality improvement infrastructure; leadership development; collaboration across organizations; pan-Canadian information systems.
Dimensions: informed; reporting; learning; just; flexible.
Contributors: leadership; patient/family engagement; teamwork and communication; openness to reporting; learning; resources; priority of safety versus production; education and training.
Teamwork and communication; safety climate; psychological safety; organizational fairness; just culture; stress recognition; working conditions; leadership; learning and improvement; patients as partners; transparency.
Six leadership domains: vision; trust, respect and inclusion; board engagement; leadership development; just culture; behaviour expectations.
Patient safety strategy/aims; senior leader communication and awareness building (e.g., walk-rounds); engage stakeholders (board, leaders, physicians, staff, patients/families) in patient safety; implement "just" culture; focus on process redesign/improved reliability (e.g., evidence-based standardization, human factors); leader/ manager/staff accountability (e.g., for safety reporting, reliable processes/"daily work") and aligned incentives for patient safety; patient safety infrastructure (staff and committees); assess patient safety culture; measure/track patient safety (e.g. mortality, trigger tool); support patients/families impacted by errors.
System-level aims; executable strategy; leadership attention; patients /families; Chief Financial Officer (CFO) as quality champion; engage physicians; improvement capability.
Person-centredness (e.g., patient involvement/stories); front-line engagement (e.g., regular presence at frontlines, visible champion, lead projects); relentless focus (e.g., talk about vision every day, align schedule with high-priority initiatives; designate resources); transparency; build will to improve (e.g., communicate and model desired behaviours, openness, swift action against undesired behaviour); boundary-lessness (e.g., systems thinking, harvest ideas from and partner with other organizations).
Quality control, improvement, culture; standardization; accountability (standard work); visual management; problem solving; escalation; integration; prioritization; daily work; policy; transparency; trust.
Leadership; psychological safety; accountability (act in safe and respectful manner); teamwork and communication; negotiation; continuous learning; improvement and measurement; reliability; transparency.
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