Enacting Behaviors

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Enacting Behaviors

The Enacting Behaviors are four behaviors employed to promote patient safety outcomes:

  • Teamwork and collaboration
  • Communication/information exchange
  • Incident reporting
  • Fair rewarding and punishing (just culture)

 

TEAMWORK AND COLLABORATION

Definition: Healthcare teams should actively participate in efforts to collaborate on task goals. Such teamwork and collaboration behaviors include monitoring, providing backup, planning, and coordinating team and individual responsibilities in operative room teams, ward teams, labor and delivery teams, and other healthcare settings.

Indication/reflection of culture factor: In all aspects of care, all staff work together as a team for the good of the patient.

Healthcare examples:

  • Care providers attend multidisciplinary workshops where they simulate effective management in crisis situations
  • Clinicians consult with each other in Multidisciplinary Discharge Rounds (MDDR) for timely completion of tasks for patient discharge
  • Multidisciplinary care providers share information and decide on a plan of care for patients during safety rounds
  • When transferring a patient to another unit, clinicians educate admitting staff and patient/family on new equipment and plan for care

Tools:

 

COMMUNICATION AND INFORMATION SHARING

Definition: The exchange of information among individuals and teams.

The extent to which messages are effectively sent and received may reflect the state of the organization’s Safer Culture. In a strong patient Safer Culture, each member considers the patient’s entire journey through the healthcare system, rather than their particular department. When transferring patient care between departments (e.g., inpatient to rehabilitation, intensive care to general ward, inpatient to outpatient primary care), personnel communicate information, confirm receipt, and close the loop by repeating back key information. Hospitals with a high Safer Culture may have a process to exchange information about safety events and actions to prevent them, which filters back to unit-based safety council meetings.

Healthcare examples:

  • Shift handoff occurs at the patient bedside and plan of care is shared with all present
  • Care providers attend multidisciplinary workshops where they role-play effective communication
  • Nurses are taught consistent verbiage (scripting) to convey to physicians when they are needed at the bedside

 

Tools:

 

INCIDENT REPORTING

Definition: Incident reporting involves individuals engaging in reporting when an error or near-miss with safety-related consequences occurs, and then categorizing incident report responses to identify any trends. By reporting errors and near-misses, employees can help ensure that safety-related issues are corrected, that personnel learn from them, and that they don’t persist. Within healthcare, reporting may occur in quality, service-line, or unit-based team meetings.

Indication/reflection of culture factor: After surgery, an OR team may perform an inventory count and realize the anesthetist used double the amount of anesthesia as usual. In a strong patient Safer Culture, team members would immediately debrief and file incident report without fear of retribution.

 

Healthcare examples:

  • Staff are committed to reporting all errors or near misses in order to improve quality and safety
  • Incidents and resolutions/outcomes are shared with staff
  • Clinicians share lessons learned with peers at staff meetings

Tools:

 

FAIR REWARDING AND PUNISHING (JUST CULTURE)

Definition: Behavior that rewards desired or effective actions when appropriate, while also enforcing fair consequences for errors that are neither excessively punitive nor lenient.

Employees understand the importance of both avoiding errors and reporting them when they do occur. Within healthcare, clinicians should only be punished if they exhibit unprofessional behavior or intentionally violate policies known to improve safety (Marx, 2003).

Indication/reflection of culture factor: Upon receiving a safety incident report from an OR team, the chief of surgery reviews the case thoroughly to find instances where both safe and unsafe choices were made.

Healthcare examples:

  • Positive patient experience anecdotes are shared with staff and they receive a standing ovation
  • Every year during nurse’s week, magnet councils elect pillars of nurses who exemplify excellence
  • Individuals are not punished when they are transparent in sharing issues/mistakes