John J. Nance Quote

The answers are perhaps as varied as the questions one asks, but a common theme that comes through in discussions with caregivers on the front lines and those who think a great deal about patient safety, is our failure to change our culture. What we have not done, they say, is create a culture of safety, as has been done so impressively in other industries, such as commercial aviation, nuclear power and chemical manufacturing. These high-reliability organizations are intrinsically hazardous enterprises that have succeeded in becoming (amazingly!) safe. Worse, the culture of health care is not only unsafe, it is incredibly dysfunctional. Though the culture of each health care organization is unique, they all suffer many of the same disabilities that have, so far, effectively stymied progress: An authoritarian structure that devalues many workers, lack of a sense of personal accountability, autonomous functioning and major barriers to effective communication. What is a culture of safety? Pretty much the opposite! Books have been written on the subject, and every expert has his or her own specific definition. But an underlying theme, a common denominator, is teamwork, founded on an open, supportive, mutually reinforcing, dedicated relationship among all participants. Much more is required, of course: Sensitivity to hazard, sense of personal responsibility, attitudes of awareness and risk, sense of personal responsibility and more. But those attitudes, that type of teamwork and those types of relationships are rarely found in health care organizations.