Group Enabling Factors

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Group Enabling Factors

Group factors impact all individuals within a team or group to a similar degree, and may differ across teams/ groups (e.g., OR team, primary care team). For example, group factors may influence how individuals within operating rooms, emergency rooms, and labor and delivery teams engage in patient Safer Culture differently. These teams may develop their own microenvironments that facilitate development of a unique organizational culture.

 

COHESION

Definition: Commitment to the group and its goals, as well as pride for the group’s values and perceived importance of being a member.

 

Cohesive teams enable group members to adopt norms, values, and assumptions supporting high safety standards.

 

Indication/reflection of culture factor: Each member of the group (OR team) commits and willingly complies with patient safety initiatives, such as doing the time-out for surgical checklist.

 

Healthcare examples:

 

  • Obstetricians, pediatricians, neonatologists, nursing, and other allied health care providers collaborate to discuss patients at safety rounds

 

  • Multidisciplinary teams meet biweekly to discuss incident reports and make improvement plans
  • Surgical team are on a first name basis in the OR to flatten hierarchy

 

  • Labor & Delivery Mother/Baby and Labor & Delivery, NICU transport team debrief in real-time any issues in patient hand-off between the units

 

  • Unit celebrations for achievement in quality standards and certifications

 

Tools:

  • Multidisciplinary discharge rounds (MDDR)- hand off sheet for each RN per shift (mother/baby unit) of milestones needing to be accomplished during shift. Reviewed per shift at handoff
  • Daily safety rounds- Charge RNs, Residents, Physicians meet daily to discuss patient cases, discharges, safety issues
  • Maternal-Fetal Triage Index Tool – Criteria to prioritize patients who present to OB triage, enabled MH to become a recognized OB-Emergency Department

 

PSYCHOLOGICAL SAFETY

Definition: A collective perception that the group is safe to take interpersonal risk. The group as a whole and its individual members believe they can speak up without fear of embarrassment, punishment, or ridicule. A healthcare team with low psychological safety may recognize a surgeon’s error but don’t speak up due to a fear of being criticized and embarrassed.

 

Indication/reflection of culture factor: Staff willingly report variances in care and participate in multidisciplinary debriefings about safety events that occur on their unit.

 

Healthcare examples:

 

  • All healthcare providers feel comfortable sharing their perspectives on incidents in discussions and debriefings

 

  • All healthcare providers openly express their opinions/suggestions in staff meetings

 

  • Everyone (i.e. patients, techs, environmental services, nurses or physicians) feel safe holding others accountable for hand hygiene

Tools:

  • TeamSTEPPS
  • Daily safety rounds — Charge RNs, residents, and physicians meet daily to discuss patient cases, discharges, and safety issues