Individual Enabling Factors
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Individual Enabling Factors
Individual enabling factors influence the extent to which employees adopt safety-related values, norms, and assumptions. Individual-level dimensions include: safety knowledge and skills, sense of control, and individual commitment and prioritization of safety. Individual factors may differ among different people within the organization (e.g., fellows, residents, interns, staff, contractors, patients and families).
SAFETY KNOWLEDGE AND SKILLS
Definition: The ability to recognize safety threats, understand their origins, and carry out procedures to address them effectively.
Employees may demonstrate safety knowledge and skills when they are selected, or may be developed through training and education. A hospital with high Safer Culture will have personnel trained on safety-related knowledge, such as how to identify and report safety threats.
Indication/reflection of culture factor: Clinicians, patients, and families have the knowledge to report safety threats and participate in quality initiatives to correct these threats.
Healthcare examples:
- Nurses and physicians annually participate in high-risk intervention and fetal monitoring education
- Units hold multidisciplinary mock codes and postpartum hemorrhage drills
- All staff involved in an incident participate in root cause analysis and process improvement
- NICU staff and Patient/Family Council members receive yellow belt training and participate in quality initiatives
- Obstetrical ER/triage nurses are trained in the Maternal Fetal Triage Index (MFTI) to correctly assess patients to consistently streamline patient acuity for admission
Tools:
- Training programs about patient safety
- Breakthroughs in Patient Safety (TB Added)
- IHI Open School: free resource for healthcare students
- AHRQ Education Resources: free resources for healthcare clinicians
- Clinical Safety and Effectiveness Course at UT (outline to be added)
SENSE OF CONTROL
Definition: The belief that one’s behavior has the potential to impact important outcomes.
When employees do not believe their actions will make a difference to safety outcomes, they are less likely to engage in behaviors that improve safety. In a strong patient Safer Culture, hospital staff are aware of their ability to impact patient safety.
Indication/reflection of culture factor: Clinicians, patients, and families complete surveys assessing their attitudes about safety outcomes.
Healthcare examples:
- Feedback is provided to individuals on the outcome of incident reporting
- Patient Safety Dashboards are shared with staff to promote goals for improvement
- Patients and families actively participate in hospital and unit-based quality councils
- Patient feedback is invited and shared with staff
INDIVIDUAL COMMITMENT AND PRIORITIZATION OF SAFETY
Definition: a positive attitude and motivation towards safe operations, and a priority of safety over all other performance goals.
Indication/Reflection of Culture Factor: Clinicians participate in daily huddles about patient safety issues and discuss patient safety on rounds.
Healthcare examples:
- Nurses (and others providing medication) follow the 5 rights prior to administering medication, even when no one is looking
- Care providers have a positive attitude towards change in processes to improve patient safety outcomes — even when processes take more time (e.g. read back of verbal orders, safety checklists, double checking high-risk medications)
- Care providers visually check patient and patient room for breach in safety precautions (e.g. lines are marked, fall precautions in place, white board updated)
Tools:
- Multidisciplinary discharge rounds (MDDR) — hand-off sheet for each RN per shift (mother/baby unit) listing milestones to be accomplished during shift. Reviewed per shift at handoff
- Maternal-Fetal Triage Index Tool — Criteria to prioritize patients who present to OB triage, enabled MH to become a recognized OB-Emergency Department