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Safety Culture


In recent years patients have died due to medical errors and negligence that happens in hospitals. A research has indicted that medical errors only claim the lives of more than 44,000 US citizens yearly and going by this it means that medical errors claim more lives than AIDS, breast cancer or even the highway accidents claim in a year. For this reason healthcare organizations have been advised to create an environment where the main goal will be the safety of its patients. Since the main objective of the organization is the safety of its patients it must therefore be engineered by the top management for it to be a success. The top leadership must understand what safety culture is first.

Safety culture in nursing and health care is combination of individual and group competencies, attitudes, values, perceptions, and patterns of behavior that determine the commitment to, and the style and ability of, an organization’s health and safety management (Sammer at el, 2010). An organization will always have a good safety culture when its communication system is based on mutual trust, it has a conscious understanding on the importance of safety culture, and when it has confidence on the preventive measure. Patient centered subculture for patient safety has several positive outcomes as outlined below (Guldenmund, 2000).

Readmission Rates

The rate at which patients come back to a health facility to be treated the same health problem recently treated is referred to as readmission rate. It is very likely that organizations which do not have a good patient centered subculture will always see its patients come back to be diagnosed with the same health problems. Researchers in the USA have indicated that that poor safety culture is always associated with high readmission rates for patients suffering with heart attacks and heart failure. Readmission rate within 30 days of discharge significantly reduces when an organization have a good safety culture that focuses on the patient (Flin, 2007).

Length at which Patients Stay in the Hospital

The aim of every patient when he/she comes to a health care facility is to be treated and return home as fast as possible. But, this is not usually the case in many hospitals because of lack of a proper safety culture that will ensure a patient is looked after. The length of stay may be prolonged if for example the patient is wrongly diagnosed and treated for the wrong disease. The equipments used which do not put the safety of the patient first can also cause this. Therefore patients will always enjoy visiting an organization that has a good safety culture as prolonged stay in any hospital means paying more bills (Feng & Weiss, 2008)


A non patient-centered safety culture will always link to increased complications whenever a patient visits a health care facility. A patient-centered hospital will encourage patients to provide information about their health related problems. Doctors may make decisions that will lead to other serious problems that would have not happened had patient talked. A safety culture that focuses on the wellbeing of patients shows the staff that they are there to serve the patient in the best way possible. It prohibits medical practices that may lead to other complications that the patient did not have. It is always positive news for a patient to come out with no related complications of the disease he/she was treated (Cox & Flin, 1998).

Mortality Rate

A patient-centered safety culture tasks the top management to challenge the medical staff and all employees to focus on the patient by offering the patient with a good experience by caring and good treatment. It also demands the management to provide the medical staff with good health care equipments that will aid in the treatment process. This means that the death rate of patients will significantly reduce if every health care organization implements the patient-centered safety culture. Good working conditions and job satisfaction are also linked to a culture that cares for the patient. There is no patient who visits a hospital to die but to come out with hope of living.

Maternity Services

Positive patient outcomes have been reported in the maternity sector where the incidences where a mother or a child dies during birth have gone down significantly. This has been linked to patient-centered safety culture because of the values that comes with it. A study recently carried in the USA asserted that proper training on foetal heart monitoring interpretation is one idea that has seen this possible. For maternal care to be effective teamwork and good communication skills in the labour room are vital. These two are emphasized in patient-centered safety culture and it gives positive outcomes on patients.

Strategies used to Promote Patient safety in the patient-centered culture

Bedside Handover

One of the strategies used to promote patient-centered culture is the clinical handover and the commonly used handover is the bedside one. Clinical handover is a situation where the responsibility and accountability for patient care is transferred from one provider or a group of providers to another. The bedside handover should be an interactive session between the nurses and the patient and it should ensure that the patient is the center of care. Bedside handover enhances the patient safety since it improves the correctness of handover communication and encourages patients to contribute on matters that affect their health. This brings satisfaction on both the patient and the nurse(s) in charge (Nieva & Sorra, 2003).

Bedside handover is an avenue in which more accurate and precise information is exchanged between nurses and provides nurses an opportunity to work hand in hand with patients. Bedside handover significantly reduces the time taken to complete a handover and it is estimated to take about 1.5 minutes on each bedside. Incoming nurses are saved their time because the handover is always detailed and it focuses on assessing the patient and identifying care priorities. Bedside handover provides the incoming nurses to ask important questions to the outgoing nurses and patients a case that leads to a safety scan and medication preview which promotes patients safety (Bishop & Flin, 2015).

Medical norms insist that any information the patient regards to be confidential should remain like and under no circumstances it should be revealed. Concerns that are linked to patient’s privacy and confidentiality are sorted out during bedside handovers. A bedside handover is important in ensuring that patient’s private and confidential details are not leaked to unwanted parties. This process taking shifts at the bedside is very effective since it provides a good working relation between medical workers and also it makes the patients to fell valued and wanted despite whatever they are going through. The bedside hand over is applied in practice using the procedure discussed below (Edwards at el, 2009).

Evidence-based essay


The bedside handover is successful only where we have a group of nurses who provide care to a group of patients. Therefore it requires good planning and preparation to effectively implement bedside handovers. When there is a working team of nurses to work in shifts they should always update the handover sheet just beside the patient to give no room of confusion. The handover sheet gives the nurses the opportunity to understand the patients by giving information like age, gender, medical history, pending tests and results, and sensitive information like HIV status therefore it is crucial it is updated during every shift (Vogus & Sutcliffe, 2007).

Other helpful information like the medication record, care plan, fluid balance sheet among others should hanged beside every patient and be continuously checked for completeness before any handover. Patients should be informed before any handover takes place as it helps them to prepare for the handover and decide what they want to say during the handover. Those who are present at the handover should be allowed only by the patient only. Patients are always advised to have their family present during the handover. This kind of attention helps the patients to see that they are important to the hospital and their families.


The leader of the outgoing group usually chairs the handover, with the other members of the group in attendance to provide any care needed to the patient during the handover. He/she introduces the incoming group of nurses to the patient and his family members if they are present during the handover. The person who co-ordinates the shifts may or may not be there depending on whether they have a patient load. If patient’s bed is in a room that have several other beds then the handover should be carried somewhere else like the nurses’ station.

Exchange of Information

A well detailed and accurate handover is necessary in making sure that the oncoming nurses continue with good care of the patient. The information exchanged is not different form that handed over using forms but the staff should be fully informed on the language they use that is they should limit the use of medical terminologies. The importance of bedside handover is that it provides an opportunity to scrutinize the information to be handed over. The incoming staff may ask questions and the patient can clarify what is being handed over. The outgoing staff is required to communicate the information precisely and in a professional manner (Stone, 2007).

Involve the Patient

The main aim of patient-centered safety culture is to ensure that they are involved in every decision that is made regarding their medical status. The patient should be given an opportunity ask questions, look for clarification and to ascertain the information given is correct. The chair of the handover should invite the patient and the family members for clarification or any other matter. Special patients like those who are asleep, confused, in isolation and those experiencing serious problems may be excluded from the handover. When patients are spoken to during the handover they automatically know that they are looked after and they also feel involved (Davis & Vincent, 2008).

Safety Scan

The huge benefit of a bedside handover is that it helps in doing a safety scan which ensures the patient safety. The scan to be done may include that of the environment, the patient and the bedside chart. The key items to look for when doing an environment safety scan include; ensuring that that patient’s call bell is within reach, all equipments are working in order, the place is tidy among other specifics related to the patient like bed height. The patient is observed if catheters are in good shape and also the bedside chart is reviewed by the incoming group leader for additional safety concerns.


Checklist is the other strategy that is used to promote patient-centered culture. In order to improve the safety of the patient and have quality outcomes, medical professionals have started to use checklists to reduce the harm done to patients and abrogate medical errors. For example in ensuring surgical safety is achieved a checklist that involves three phases of surgery was developed and implemented by the WHO. The checklist emphasizes that before the induction of anesthesia, before skin incision and before the patient leaves the OR a series of safety checks at each phase must be carried out and it should involve every member of the surgical team (Armstrong & Laschinger, 2006).

The team must conduct a verification process where all members of the team are required to agree before any procedure is started. When such a checklist is used there is a guarantee that he/she will come out the surgery with no further complications which is very positive to the patient. Although the WHO has developed and implemented use of checklist it is good to note that their effectiveness depends on their quality and thoroughness, acceptance and compliance by staff, and a strong culture of safety in the organization (Haugen at el, 2013).

The implementation of a formalized checklist significantly reduces errors that result from lack of information and inconsistent procedures. Checklists have improved the way hospitals discharge and transfer patients as well as how patients in the intensive care and trauma units are looked after. Besides assuring the safety of the patient it also creates a great sense of confidence that the process is completed accurately and thoroughly. The strategy of using checklists has positive outcomes on the health where it significantly reduces mortality rate, injuries and other patient harm. A research by the World Health Organization indicates that when the checklist strategy was implemented major post-surgical complications at the hospitals fell 36 percent and deaths decreased by 47 percent (Hughes & Lapane, 2006).

Embracing Change by Staff Members

Since bedside handover and checklist are a change in culture of any health organization a good safety strategy is required to ensure that the change is embraced by the staff. An example of such strategy is assembling a multidisciplinary implementation team that will assess the emerging issues as a result of the change. The nurses, physicians, surgical technologists, and administrators should be rallied by the team to accept the change as it promotes patient’s safety. Forming such a team by any medical organization is a critical step in accepting the culture change.

Staff members should be encouraged that the benefits of embracing the culture change are more than those of rejecting it. For example, the part where checklists require team members to introduce themselves before any procedure starts may form a basis for a team member to speak up later in procedure when he/she identifies a problem. Another benefit of checklist is the debriefing that is always done in OR at the end of each surgery provides the member with an opportunity to learn from mistakes and improve them in future surgeries.

The multidisciplinary implementation team should conduct one-on-one conversations with staff members to curb the opposition to culture change. A private and direct meeting with the resisting staff members can be useful if it is well planned and tailored to specific concerns. Concerns like the time taken on completing a checklist would add to surgeries should be addressed since many surgeons fear that the surgery procedure may be long if they use checklists. Although it is not guaranteed that face-to-face conversation will be effective an early attempt should be made and the resisting members may change in future (Hellings, 2007).


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