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People Based Patient Safety
2013 SC Patient Safety Symposium
Josh Williams, Ph.D. Safety Performance Solutions
610 N. Main Street, Suite 228 Blacksburg, VA 24060
www.safetyperformance.com
(540) 951-1032
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Common Themes
in an Ideal Safety Culture.
Senior managers invest sufficient money and resources to
ensure a safe work environment.
Safety is not compromised when determining schedules,
overtime, and staffing.
Senior managers spend time talking one-on-one with
employees about safety.
Supervisors don’t put time pressure/production ahead of
safety.
Supervisors praise employees for working safely.
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Common Themes
in an Ideal Safety Culture.
Supervisors caution employees respectfully for risky
behaviors (improper lifting with patient transfer, bed rails
not in place, trip hazards on floor, medication storage).
Employees caution each other about at-risk behaviors and
do so respectfully and employees appreciate safety
feedback from others.
Employees don’t take safety shortcuts.
Employees work safely when supervisors aren’t around.
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Exercise: Define An Ideal Safety Culture.
List characteristics of an ideal safety culture. Be sure to consider specific behaviors and
attitudes of people, as well as the environment.
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A Total Safety Culture Requires a Shift
from Dependence to Interdependence
Improving Safety Behavior
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SAFETY
CULTURE
Focus on 3 Areas to Improve
Safety Culture.
ENVIRONMENT
Equipment, Tools, Machines,
Housekeeping, Climate,
Management Systems
BEHAVIOR
Putting on PPE, Lifting properly, Following procedures,
Locking out power, Cleaning up spills,
Sweeping floors, Coaching peers
PERSON
Knowledge, Skills, Abilities,
Intelligence, Motives,
Attitude, Personality
BEHAVIOR
Putting on PPE, Lifting properly, Following procedures,
Locking out power, Cleaning up spills,
Sweeping floors, Coaching peers
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At-Risk Behavior
Contributes to Most Injuries.
Inju
ry
9
0
20
40
60
80
100
Values
(Should)
Intentions
(Willing)
Behaviors
(Do)
Perc
ent A
gre
em
ent
...caution coworkers when observing
them perform at-risk behaviors.”
...caution coworkers when observing
them perform at-risk behaviors.”
...caution coworkers when observing
them perform at-risk behaviors.”
Our Actions Don’t Always Match Our Values.
“I do ... “I am willing to ... “Employees should ...
90% 85%
60%
From more than 100,000 survey responses, people said…
Goal
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Sometimes the “System” Motivates the
Wrong Behavior.
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Reasons Why We Take Risks
Bad Habit
Peer Pressure
Lack of Accountability
Time Pressure
Poor Communication
Poor Ergonomic Job Design
Confusing Procedures
Inadequate Training
Low Expectations Set by Supervisor
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Unsafe Behavior is Often
the Result of System Influences.
No
At-Risk Behavior
Yes
Did operator purposefully perform
a behavior which
s/he knew to be unsafe?
Human Error Calculated Risk
Individual
Variance System-Induced
Human Error
System-Encouraged
Behavior
Willful Negligence
Act of sabotage
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The ABC Model
Explains Why We Do What We Do.
Activators
Consequences
Behavior Motivate
Direct
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Activators and
Consequences Take Many Forms
Activators: Safety Meetings, Goal setting, Rules and Regulations, Policies and Procedures,
Incentives/Disincentives, Instructions, Signs, Training, Modeling, Saying please
Behaviors: Patient transfer (lifting), hand washing, storing medication, pinch points with
wheelchairs, hairnets, jewelry, verbal confirmation with patients, bed rails in place,
dry floors
Consequences: Self-approval, Reprimand, Peer approval, Penalty, Feedback, Injury, Prize or
trinket, Inconvenience, Thank-you, Time savings, Comfort
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Some Tasks Have Natural
Rewarding Consequences.
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Safe Behaviors Often Lack
Natural Rewarding Consequences.
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Safety Is a Continuous
Fight with Human Nature.
At-risk behaviors are often more comfortable, convenient, and faster
than safe behaviors.
At-risk behaviors are often reinforced by the work culture.
At-risk behaviors rarely result in negative consequences (e.g., injury,
reprimand) powerful enough to discourage their performance.
Initial safety awareness and carefulness is often short-lived because
of a natural learning process called drift.
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How Should We Motivate Safety?
Improving Management Practices
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Management Approval is an
Especially Powerful Motivator.
People tend to “obey”
authority.
Managers control or influence
many consequences.
Pay
Promotion
Discipline
“What’s Important to the Manager
is Important to the Employee.”
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Without Care, Leaders May
Reinforce At-Risk Behaviors.
A. Fail to reinforce a safe behavior
B. Fail to coach an at-risk behavior
C. Reinforce competing behaviors
D. Model at-risk behaviors
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A. Why Would Leaders Not
Reinforce Safe Behavior?
“It’s their job.”
Too busy
Don’t notice safe behaviors.
They think it’s a waste of time.
Without Reinforcing Consequences, Desirable
Behaviors May Stop.
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B. Why Would Leaders Not
Coach At-Risk Behavior?
It’s uncomfortable confronting others.
Production demands
Don’t believe the behavior will change anyway.
It’s not seen as a big deal.
Don’t want to look foolish or don’t know the job that well.
Failure to Coach Undesirable Behavior Implies
Acceptance.
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C. Why Would Leaders Focus
on Productivity Over Safety?
Greater organizational pressure for production vs. safety.
Production = Direct responsibility of leaders.
Leaders are held accountable for production.
Production is easily measured.
Focusing on Only on Production Demonstrates A Higher Priority Than Safety.
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D. Why Would Leaders
Model At-Risk Behavior?
Don’t know better
Risky habits
Don’t think anyone will notice.
Don’t have the same exposure level as employees
Modeling risky behaviors undermines safety credibility.
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D. Leaders Need to “Walk the Talk.”
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Be Careful with Modeling.
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Communication Skills
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Several Communication Styles
Impact Safety Feedback.
Sheriff- Direct and task oriented
Diplomat- Supportive and inclusive of others
Investigator- Accurate and detail oriented
Most individuals have various levels of all three styles depending on the situation.
Adapted from Poertner & Miller, 1996
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Sheriffs Have Certain Attributes.
Strengths
Direct
Practical
Big Picture
Task-oriented
Closure-oriented
Weaknesses
Impatient
Overly independent
Combative
Insensitive
Domineering
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Diplomat Have Certain Attributes.
Strengths
Supportive
Patient
Consistent
Actively listens
Responsive
Weaknesses
Avoids confrontation
Passive and indecisive
Slow to change
Slow to initiate ideas
Withholds feelings
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Investigators Have Certain Attributes.
Strengths
Accurate
Well prepared
Analytical
Systematic
Detail oriented
Weaknesses
Loses forest for trees
Inflexible
Micromanaging
Overly cautious
Unrealistic standards
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Loses forest for trees,
Inflexible, Micromanaging,
Overly cautious, Unrealistic
standards
Impatient, Overly
independent, Combative,
Insensitive, Domineering
Each Communication Style Has
Unique Strengths and Weaknesses.
Style Strengths Weaknesses
Sheriff
Diplomat
Investigator
Direct, Practical,Big
Picture Focus, Task-
oriented, Closure-oriented
Supportive, Patient, Easy-
going, Consistent, Actively
listens, responsive to others
Accurate, Well-prepared,
Analytical, Systematic,
Detail-oriented
Avoids confrontation, Passive
and indecisive, Slow to change,
Slow to initiate ideas,
Withholds true feelings
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DIRECTIONS: Consider your own communication patterns. Rate yourself from 1 to 10 in terms of how strongly you fit each category. Higher scores represent a stronger fit for that category. For instance, you may be a “2” for Sheriff, “10” for Diplomat, and “5” for Investigator. Do not give any two categories the same rating number. Do not share your self-assessment with others.
After everyone has written down their own ratings, various group members will be selected for others to rate their communication styles. Do we rate ourselves the same way others rate our communication style?
Rating of Rating of Rating of Rating of Self Another Another Another
Sheriff
Diplomat
Investigator
Exercise: Determine Your Level of
Each Communication Style.
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Effective Communicators
Appreciate Diverse Styles.
Recognize the strengths and limitations of all three
communication styles.
Be flexible in your preferred communication style.
Different situations may require different styles.
Develop a more holistic communication style.
Accept diverse communication styles in others.
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General Communication Guidelines
Show respect for others’ opinions. Thank others for their input.
Ask questions to facilitate discussions (vs. constant lectures).
Share information about yourself to maintain rapport.
Ask others about themselves and how they are doing.
Be sincere and genuine.
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General Communication
Guidelines, Cont.
Use appropriate, tasteful humor.
Speak constructively and positively.
Confront problems as soon as they occur.
Don’t let negative feelings build up.
Express opinions directly and honestly.
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Follow These Guidelines
When Giving Recognition for Safety.
Give it one-on-one.
Be SINCERE.
Don’t always follow up with corrective feedback.
Nice job, but….
Give praise and recognition more often.
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Recognition Matters.
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Follow These Guidelines
When Giving Correcting Feedback.
Give it one-on-one, immediately, and focus on
behavior.
Show concern for others’ feelings and well being.
Give the receiver a chance to respond.
Discuss alternate methods together. Don’t nag.
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Guidelines For Receiving Correcting Feedback
Be objective, not defensive.
Avoid unnecessary arguments.
Accept feedback without anger.
Thank the person for trying to help.
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Levels of Listening
1. Ignoring
2. Pretending
3. Selective
4. Active
5. Empathic
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Choose Your Words Carefully.
Use ‘I’ statements.
State your opinions as opinions, not facts.
Use safe and at-risk instead of right and wrong.
Use at-risk instead of unsafe.
Avoid using absolutes such as must, never, and always.
Avoid labeling person factors; focus on the behavior.
Use corrective instead of negative feedback. Talk about areas
of concern, or opportunities for injuries.
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Additional Communication Skills
Active Listening
Don’t interrupt
Ask open-ended questions to clarify meaning
Paraphrase but don’t parrot
Non-Verbal Communication
Eye contact
Personal space
Vocal tone
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There are Various
Communication Patterns.
1. Dominant
2. Passive
3. Passive-Aggressive
4. Empathic
The empathic communication pattern is most effective. Other patterns are ineffective and can damage organizational culture.
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Dominant Communicators
Thoughts “Others should think the way I do.”
“I am seldom if ever wrong.”
“People who disagree with me are either disloyal or misinformed.”
Behaviors Publicly criticizes others.
Blames others when problems arise.
Bossy, bullying, and negative.
Fails to show appreciation for others’ accomplishments.
Frequently interrupts others, finishes others’ sentences.
Dismisses new ideas without hearing the rationale first.
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Passive Communicators
Thoughts “Don't express your true feelings.”
“Don't make waves.”
“Don't disagree with others.”
Behaviors Remains quiet even when disagreeing or being treated unfairly.
Asks permission unnecessarily.
Spends too much time avoiding conflict.
Tends to be overly self-critical and overly agreeable.
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Passive-Aggressive Communicators
Thoughts “When you have an issue with someone, go behind their back.”
“Build coalitions against others instead of dealing with people directly and
honestly.”
“Get back at others if they cross you, even if it takes a while.”
Behaviors Appears to agree with others when they really don’t.
Expresses concerns about an individual to other people instead of that person
directly.
Holds grudges and values “getting even.”
Frequently gossips.
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Empathic Communicators
Thoughts “Personal opinions and the opinions of others are important.”
“The process of coming to a decision (not just the decision itself) is important.”
“Getting input from others boosts morale and generally leads to better decision
making.”
Behaviors Communicates using choices instead of demands.
Tends to be proactive, assertive, and action-oriented.
Tends to be realistic in expectations.
Communicates in a direct, honest manner.
Works to achieve goals without compromising others.
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Most of the Message We Send To Others Is Through
Body Language and Vocal Patterns (Voice).
55%38%
7%
Body Language
Voice
Words
- Albert Mehrabian
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Identify These Emotions as Conveyed Through
Body Language and Facial Expressions
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Identify These Emotions as Conveyed Through
Body Language and Facial Expressions
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Identify These Emotions as Conveyed Through
Body Language and Facial Expressions
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Identify These Emotions as Conveyed Through
Body Language and Facial Expressions
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Follow These Guidelines to Improve Body
Language and Vocal Patterns.
Smile sincerely.
Don’t fidget.
Maintain eye-contact.
Watch vocal volume.
Loud volume reflects aggression.
Soft volume reflects weakness.
Watch pace of speaking.
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Here are Guidelines for Communicating with
Difficult People.
Don’t take it personally.
Keep your cool.
Exchange information not emotion.
Let them know you understand the message but don’t
appreciate the delivery.
Don’t lose sleep over it. They don’t suffer when you are
upset, you do.
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Follow These Guidelines When
Communicating Through Email. Use verbal feedback, not email, for sensitive issues.
Keep the language constructive and focused on problem solving.
Be as concise and direct. (Also important with voice mail.)
Watch for spelling errors.
Avoiding bombarding people with an excessive number of emails at a given time (especially in companies with slow servers).
Respond to emails as quickly as possible.
Don’t use ALL CAPS or colors.
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Exercise: Key Aspects of
Communication
List the key aspects of effective communication.