Chapter 20c. [Vignette] Creation of a Patient Safety Culture: A Nurse Executive Leadership Imperative

In 2004, the Healthcare Leadership Alliance, which includes the American Association of Nurse Executives and other health care executives, identified a core set of competencies for executive leaders in health care. The identified core competencies for nurse executives in health care were: (a) leadership, (b) business skills and principles, (c) communication and relationship management, (d) professionalism, and (e) knowledge of the health care environment. Patient safety is identified as a key element of concern in the health care environment. Within the context of the core five competencies listed above, seven imperatives were identified to develop a patient safety culture: 1 • To support the development and implementation of an organization-wide patient safety program • To design safe clinical systems, processes, policies, and procedures • To monitor clinical activities to identify both expected and unexpected risks • To support a nonpunitive reporting environment and reward systems for reporting unsafe practices • To support safety surveys, responding and acting on safety recommendations • To ensure staff is clinically competent and trained in their roles in patient safety • To articulate and take action in support of the Joint Commission’s National Patient Safety Goals These imperatives are the necessary building blocks the nurse executive must communicate to foster the development of a culture of proactive patient safety. This vignette will first review the historical background of the evolution of a patient safety proponent. From lessons learned in the redesign of an entire hospital culture, a model “Systemic Mindfulness Model of Proactive Patient Safety” is presented. Using a corkscrew metaphor and systems theory, the model suggests that all levels and professions of the health care culture must become aware and responsible to achieve meaningful medical error reductions. Practical suggestions are then offered, which derive directly from the model for achieving and maintaining a culture of proactive error reduction. The skillful acquisition of the five core competencies and the implementation of the seven patient safety imperatives are necessary for these practical suggestions to be truly effective.