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Culture of Safety
In dentistry and healthcare in general, a “Culture of Safety” involves a commitment to the safety of patients and personnel by everyone in the organization (office/institution), including management. The Safest Dental Visit™ requires that a Culture of Safety be present and includes a commitment to the relevant CDC guidelines and all applicable OSHA standards and requirements.
Implementing and working in a positive culture of safety means:
- Individual accountability and commitment for safety is promoted
- Protocols and activities promoting safety are suggested, planned, and implemented
- Mechanisms are in place to determine if safety guidelines and policies are followed
- All employees and personnel are empowered to make suggestions/voice safety concerns - Download Infection Control in Practice "Who is Managing Your Safety Culture"
- All employees and personnel are involved in the decision making
- A protocol is in place to address suggestions/concerns related to improving safety
- All personnel, including management, receive initial training, OSHA-mandated training, and updates when mandated and when changes are made
- Reporting systems are in place for safe behaviors, injuries, near misses, and hazards
- To show the differences when safe behaviors are in place
- To investigate, make corrections, prevent a recurrence, ‘provide follow-up care
- A post-exposure management program that follows the guidelines of the U.S. Public Health Service is in place (and is required by OSHA)
- Management is involved, supports related activities
- Resources are committed to safety (e.g., money for safety devices such as needless injection systems, sharps devices, cassettes)
- Systems are in place to acknowledge safety practices (e.g., recognition, award points)
- Adverse events related to patient care are reported, investigated, and remediated
- Dental care is patient-centered. The Institute of Medicine (IOM) defines patient-centered care as “Providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.” Safety is a value of patient-centered care.
- Patients are informed of the risks, benefits, and alternatives to the proposed treatment.
Staff meetings are an opportunity to review results, obtain suggestions and make recommendations. These can occur at least monthly or more frequently. Additional meetings are required to report breaches, take corrective action and provide (re)training.
Measuring a culture of safety
Surveys are available that measure whether personnel believes their work environment has a positive culture of safety, where they are empowered (vs. fearing reprisal).
Mechanisms to determine adherence to safety guidelines and policies
1. Observations and reviewing records and logs help to determine adherence. Examples of observations that measure adherence include:
- Are surfaces uncluttered?
- Are floor areas clear and free of cables and other obstacles
- Compliance with hand hygiene – is it being performed and supplies being used at the rate you would expect?
- Compliance with PPE – is everything wearing appropriate PPE when you do spot checks and are they wearing it properly? Is it being appropriately disposed of?
- Are work practices geared to safety routinely followed?
- Are the fire extinguishers accessible and working?
- Are hazardous materials isolated and accessible only to authorized personnel?
- Is waste being disposed of properly?
2. Checklists can be used to determine compliance with safety and infection control.
3. Review adherence to your written safety and prevention plans and policies required by OSHA. This can help identify any gaps or improvements that may need to be made, including in the policies themselves and practices that help adherence.
What to do when injuries/near misses/hazards occur?
Fully investigating these without placing blame fosters a continued positive culture while finding out why the event occurred, after which corrective action can be implemented and then reassessed days/weeks and months later. If necessary, further action can be taken to improve safety.
Resources
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