How can hospital culture be improved?

Culture. It’s “the way we do things around here.” It’s the normal or expected attitudes, beliefs, and behaviours that you share with your colleagues. In health care, culture influences how well we work together, how well we communicate with each other, our dedication to safety and, ultimately, how well we care for patients.

Positive shifts in workplace culture are linked to improved system-related and clinical outcomes, reduced adverse events and increased patient satisfaction. These shifts also have tangible benefits for health care providers, teams and organizations by reducing work-related conflict and stress, fostering team communication to lessen harassment and bullying and improving job satisfaction and perceptions of working conditions. To foster these shifts, we support and lead a number of culture change activities. Explore these pages to learn about our culture initiatives and how you can join us in shifting culture to support positive changes.

Culture Improvement Resources

We all shape the cultures of organizations and teams we work within by how we communicate and interact with our colleagues. Improving cultures has been linked to better system-related and clinical outcomes, reduced adverse events and increased patient satisfaction1.

But before we can improve cultures we need to measure and understand them, and there are many resources available to help do so. Some of our partners recently shared a need for research which could identify best practices of common measurement tools.

We conducted a rapid review of the literature – the report looks at seven common surveys used in health care settings to measure culture and offers data to support their use.

Our Culture Change Toolbox features 21 tools and interventions for changing culture, along with tips on how to apply them.

In many work environments there are opportunities to improve culture. While this may seem like a daunting task, the good news is that we all, individually and collectively, have the power to do it.

The toolbox outlines the steps that we can take to shift culture in health care: engaging people, setting foundations, assessing the current state, identifying and analyzing opportunities, choosing tools, and testing changes.

Communication breakdowns often seem small and go unnoticed, when they can greatly influence the outcome of patient safety and quality of care1. Shifting to a healthier culture is not an easy task but it starts with the question: “How well does my team communicate?”

This three-minute video and companion guide help to address “the elephant in the room” and improve your group’s teamwork and communication.

After watching the video, use the guide facilitate a debriefing conversation with your team. By engaging teams with a creative and non-clinical example, we hope to provide an opportunity to hone your observation skills and work to develop and improve how your team communicates.

Transform your team and ignite change! The website features over 30 activities – and counting. Each activity comes with instructions on how to lead it and debrief afterwards, as well as information on the time, number of participants and resources required.

Categories include:

• Adaptive systems: Inspire change to suit evolving environments
• Communication: Improve the way information is understood
• Creativity & innovation: Train your mind to think outside the box
• Teambuilding: Lean to leverage all the talent from your peers

View and Download Activities at ATTIC’s Website

References

1. Braithwaite J, Herkes J, Ludlow K et al. Association between organizational and workplace cultures, and patient outcomes: systematic review. BMJ Open 2017; 7: 1-12

• Home
• Hospital Peer Review
• March 1, 2016

<p> Hospitals strive to have the right culture, particularly when it comes to patient safety, but measuring improvement can be challenging. It&rsquo;s not enough to strive for a health culture, says one expert. You also have to know if you&rsquo;re getting any closer to your goal.</p>

March 1, 2016

Reprints

Related Articles

• Primary Care Is on Life Support, But Case Management Could Be Antidote
• Better Care Coordination Needed for Interhospital Transfers
• Possible Solutions to Poor Interhospital Transfers
• Intensive Care Management Works with Complex Medicaid Population
• ACO’s Comprehensive Patient Navigation Can Reduce Costs, Increase Satisfaction

Hospitals strive to have the right culture, particularly when it comes to patient safety, but measuring improvement can be challenging. It’s not enough to strive for a health culture, says one expert. You also have to know if you’re getting any closer to your goal.

The idea of a hospital’s culture is challenging enough for many people, but the idea of measuring it can be even more difficult, says Catherine Miller, RN, JD, senior risk management and patient safety specialist for the Cooperative of American Physicians in Los Angeles.

“All of the major patient safety leaders really think that culture most significantly impacts patient safety, worker happiness, and patient outcomes,” Miller says. “It’s nebulous, it’s hard to get your arms around it and define it, but you can see it and feel it. And you can measure it.”

A working definition of hospital culture is the attitudes, behaviors, beliefs, and expectations of an organization, Miller says. A more folksy definition is “the way we do things around here,” she adds. In hospitals with a good safety culture, people feel supported, that they have tools to do the job, that they are listened to, and they can escalate patient safety concerns without fears of retaliation, she says. A good safety culture correlates with fewer infections, fewer readmissions, and overall better patient outcomes.

A multi-pronged approach is best when measuring culture, Miller says. The Joint Commission requires that hospitals annually survey and assess their safety culture, and there are several tools available. One that Miller recommends is the Hospital Survey on Patient Safety, created by the Agency for Healthcare Research and Quality, available online at http://tinyurl.com/pzm62sn. The survey asks questions of hospital staff such as whether they have enough staff to handle the workload, whether people treat each other with respect, and if the respondent can escalate a patient safety concern without fear of reprisal.

“Surveying your folks is a good way to start improving your culture because you get a baseline,” Miller says. “Another thing to consider doing is conducting patient safety rounds and interviewing staff. Maybe when you get the survey results that is a good time to go out on the floor and try to drill down deeper into any issues that were identified there.”

Interviewing patients and family members also can yield great insight, Miller says. The most useful information can come from long-term and frequent flier patients because they have the most exposure to the hospital, she notes.

A common mistake when trying to improve hospital culture is to underestimate how long the process will take, Miller says. She likens it to a political campaign — long and arduous, but you should be able to tell if you’re winning or not.

“It’s easy to think that if you get out there and promote your mission statement, staff will align themselves with it. Then that’s it and after a while you have a culture of safety,” Miller says. “That’s not enough. It’s very much dependent on leadership guiding this from the top down, having a presence at new employee orientation, every chance they get to be seen advocating for a culture of safety.”

Periodically, you should reassess the culture by surveying staff at least annually as required by the Joint Commission, but perhaps more often to explore specific areas that you are trying to improve. Also, don’t underestimate the value of face-to-face discussions with managers and frontline staff, Miller says. Data from surveys and other tools is essential, but sometimes your best assessment of progress will come from the few minutes you spend chatting with a nurse who happened to be walking by. You may hear that he or she has noticed real improvements in the way staff feel about the culture of safety, and you may hear that there are still particular issues that need more attention.

“Leadership can get so bogged down with meetings and other distractions that they find it hard to get out on the unit and connect. Just getting out there and introducing themselves is one way they show their commitment to the culture of safety, so you can’t downplay the importance of just walking onto a unit and saying hello,” Miller says.

SOURCE

• Catherine Miller, RN, JD, Senior Risk Management and Patient Safety Specialist, Cooperative of American Physicians, Los Angeles, CA. Telephone: (800) 252-7706.

Hospitals strive to have the right culture, particularly when it comes to patient safety, but measuring improvement can be challenging. It’s not enough to strive for a health culture, says one expert. You also have to know if you’re getting any closer to your goal.

You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.

What can be improved in hospitals?

How can NHS improve culture?

What should be the culture in a hospital?

How can hospitals improve quality?