Presentation
How Proactive Safety Programs Proactively Manage the Safety of Hospital Work: A Multiple Case Study Analysis
SessionPoster Session 1
DescriptionProactive safety (PS) is a modern approach to safety that seeks to understand complex adaptive systems in new ways to generate foresight about the changing shape of risk in work systems and intervene before harm occurs. Increasingly over the last decade, proactive safety programs (PSPs) are being implemented in healthcare organizations to implement suites of science-based interventions designed to advance the organization’s capabilities beyond reactive and responsive safety work. However, it can be challenging for interested organizations to become aware of the proactive work being undertaken by other programs in their industry or indeed across industries. While published case studies offer prospective PS practitioners examples of PS interventions, an association of healthcare interventions with their implementation challenges and the strategies PSPs used to mitigate those challenges has not previously been described. Appreciating these patterns of contributing factors can be informative to designing sustained implementations of PS interventions.
This presentation will share the findings of a synthesis of proactive safety work in patient safety programs across several hospitals in the United States. PSPs in this study included official and unofficial, embedded and independent, externally funded and employee, leader-appointed and grassroots teams performing PS work. PS practitioners leading these PSPs varied in their educational backgrounds, primary areas of expertise, frontline healthcare experience, and leadership objectives for the work and for their team. Across these diverse programs, patterns emerged among their interventions, implementation challenges, and challenge mitigation strategies, such that general patterns among the types of PS work and the durability of implementations could be revealed.
The presentation will describe these types of PS work, which included uniquely PS work as well as PS work that was designed to complement traditional safety management system (SMS) work. Uniquely PS work included
- Methods used by PSPs to perform healthcare work system analysis
- Novel mindsets introduced by PSPs into their patient safety departments
- Procedures and workflows introduced by PSPs into patient care settings
The challenges encountered by PSPs performing these PS work functions were centered around mental model misalignment with stakeholders across the organization about organizational safety and how to pursue it. PSPs managed mental model alignment by mitigating the most undesirable consequences of mental model misalignment. Specifically, they enacted multiple, simultaneous continuous cycles similar to the perception-action cycle (Neisser, 1976; Rayo et al., 2012) to monitor, interpret risks in context, and respond to critical risks associated with mental model misalignments amidst a landscape of mental model alignment. Given the PSP leaders’ extensive experience in their organizations and industry, they were also able to develop the capacity to anticipate the risk for increased mental model misalignment across all phases of implementation, such as leadership turnover during sustainment vs. scaling of the program.
In addition to PSPs performing uniquely PS work, they engaged in PS work that complemented SMS work. Examples of these work activities include
- Seeding PSP work with SMS findings, such as following up on errors to ask different “why” questions for additional context
- Comparing SMS analysis of SMS data to related PSP analysis of PSP data on the same topic and following up on the gaps
- Partnering with or facilitating future partnerships with SMS work groups
A primary benefit and result achieved by PSPs performing these complementary work functions was an increase in the PSP’s perceived legitimacy by SMS and SMS-adjacent workgroups such as training and quality. Establishing the PSP’s perceived legitimacy among these peer stakeholder groups then facilitated interactions across the organization from senior leadership to frontline staff. In other situations, dissemination of the PSP findings seen to reveal nuance in operations and insight into intractable problems helped to distinguish the PSP from the SMS, which also increased the PSP’s perceived legitimacy.
Healthcare organizations seeking to initiate proactive safety work or develop proactive safety programs can benefit from learning how these successful programs are achieving sustainment and scaling their work. Furthermore, the implementation strategies revealed by this study can be enacted across levels of the organization and by individuals of varying authority to direct change because they hinge on core values in healthcare organizations: competency, collegiality, generating value, and cultivating a deep understanding and empathy for patients and for fellow healthcare workers.
This presentation will share the findings of a synthesis of proactive safety work in patient safety programs across several hospitals in the United States. PSPs in this study included official and unofficial, embedded and independent, externally funded and employee, leader-appointed and grassroots teams performing PS work. PS practitioners leading these PSPs varied in their educational backgrounds, primary areas of expertise, frontline healthcare experience, and leadership objectives for the work and for their team. Across these diverse programs, patterns emerged among their interventions, implementation challenges, and challenge mitigation strategies, such that general patterns among the types of PS work and the durability of implementations could be revealed.
The presentation will describe these types of PS work, which included uniquely PS work as well as PS work that was designed to complement traditional safety management system (SMS) work. Uniquely PS work included
- Methods used by PSPs to perform healthcare work system analysis
- Novel mindsets introduced by PSPs into their patient safety departments
- Procedures and workflows introduced by PSPs into patient care settings
The challenges encountered by PSPs performing these PS work functions were centered around mental model misalignment with stakeholders across the organization about organizational safety and how to pursue it. PSPs managed mental model alignment by mitigating the most undesirable consequences of mental model misalignment. Specifically, they enacted multiple, simultaneous continuous cycles similar to the perception-action cycle (Neisser, 1976; Rayo et al., 2012) to monitor, interpret risks in context, and respond to critical risks associated with mental model misalignments amidst a landscape of mental model alignment. Given the PSP leaders’ extensive experience in their organizations and industry, they were also able to develop the capacity to anticipate the risk for increased mental model misalignment across all phases of implementation, such as leadership turnover during sustainment vs. scaling of the program.
In addition to PSPs performing uniquely PS work, they engaged in PS work that complemented SMS work. Examples of these work activities include
- Seeding PSP work with SMS findings, such as following up on errors to ask different “why” questions for additional context
- Comparing SMS analysis of SMS data to related PSP analysis of PSP data on the same topic and following up on the gaps
- Partnering with or facilitating future partnerships with SMS work groups
A primary benefit and result achieved by PSPs performing these complementary work functions was an increase in the PSP’s perceived legitimacy by SMS and SMS-adjacent workgroups such as training and quality. Establishing the PSP’s perceived legitimacy among these peer stakeholder groups then facilitated interactions across the organization from senior leadership to frontline staff. In other situations, dissemination of the PSP findings seen to reveal nuance in operations and insight into intractable problems helped to distinguish the PSP from the SMS, which also increased the PSP’s perceived legitimacy.
Healthcare organizations seeking to initiate proactive safety work or develop proactive safety programs can benefit from learning how these successful programs are achieving sustainment and scaling their work. Furthermore, the implementation strategies revealed by this study can be enacted across levels of the organization and by individuals of varying authority to direct change because they hinge on core values in healthcare organizations: competency, collegiality, generating value, and cultivating a deep understanding and empathy for patients and for fellow healthcare workers.
Event Type
Poster Presentation
TimeMonday, March 234:45pm - 6:15pm EDT
LocationRhinelander Gallery
Hospital Environments