At its core, culture of safety in the oral and maxillofacial surgery (OMS) office means patient safety is the number one priority. The policies and actions of the doctors and staff in the practice are concentrated on that primary objective.
Patient safety is the number one priority
Development of and adherence to a culture of safety is not a promise of perfection. While the culture acknowledges that as human beings, we are all capable of making mistakes, it further holds that we are capable of recognizing our errors and identifying ways to prevent them from happening again.
Through team meetings, self-reporting and an environment that encourages collaborative thinking to improve policies and procedures, OMS offices promptly identify errors and their causes and take action to prevent their reoccurrence. The objective of the culture of safety is to be proactive, with the goal of preventing untoward events from occurring at all.
Defined by the Centers for Disease Control as "the shared commitment of management and employees to ensure the safety of the work environment," experts agree that to create a culture of safety requires certain essential steps must be taken:
- Assess the culture that currently exists in the practice: which systems or activities are working and which are not; techniques for improving problem areas; methods for implementing improvements; and ways in which those improvements may be evaluated and deemed a success or failure.
- Promote the team concept and assure that each member understands their role and how it interconnects with other team members. Cross training and collaboration are important so that members learn to appreciate the role and abilities of others and make intelligent judgments regarding who should be in charge of a particular activity.
- Employ systematic reporting and monitoring procedures to help identify potential errors or pitfalls that may result in an adverse healthcare situation. In order to prevent a similar situation in the future, staff should be encouraged to voluntarily report or discuss systemic problems.
- Create transparency. It frees staff to discuss problems without fear of reprisal and indicates there is an honest acceptance of human error, whether actual or potential and a commitment to rectifying problems.
- Establish accountability. Accountability is often confused with culpability. In the context of a culture of safety, accountability is a way of ensuring that everyone involved in the team, from the OMS to the receptionist, and including the patient/caregiver, is aware of their personal responsibility to strive for safety at all times.
The culture of safety concept was first conceived by the aviation industry. In the 1970s, the industry suffered a number of accidents attributable to human error. In response, the industry changed its standards and operations drastically. By implementing cross training, checklists, and better communication channels for now-empowered crewmembers, the safety record of the aviation industry today is an enviable one. Because of that success, it was to the aviation industry that health care, particularly hospital organizations, looked for examples when deciding to formulate its own culture of safety.
The Institute for Healthcare Improvement (IHI) has estimated that approximately 80 percent of medical errors in the hospital environment are system-derived. Echoing this sentiment is a report by the Institute of Medicine, To Err Is Human: Building a Safer Healthcare System, which concludes, "The majority of medical errors do not result from individual recklessness or the actions of a particular group—this is not a 'bad apple' problem. More commonly, errors are caused by faulty systems, processes and conditions that lead people to make mistakes or fail to prevent them."
By adapting and implementing many of aviation's practices, the number of serious patient injuries in hospitals has declined. Surgeons in hospitals adopting these practices are now used to such procedures as a "time out" before making an incision to review that the correct procedure is being done on the correct patient and making certain the operative site is well marked while the patient is awake to ensure the correct site of surgery is identified. These are in addition to such time-honored practices of conducting pre-closure needle and sponge counts and fanatically adhering to sterile techniques.
OMS offices are, in many ways, microcosms of hospital surgery centers. Complex surgical and anesthetic procedures are regularly conducted there and yet, despite the similarities, relatively few serious patient injuries occur. However, even in the best-managed facility, the unexpected can happen. Many oral and maxillofacial surgeons have found that by reassessing the way in which their teams respond to errors, they can in fact reduce the number of mistakes and misadventures that could potentially impact patient care.
Patients play a vital role in the culture of safety
Patients, too, play a vital role in maintaining the culture of safety, especially with regard to communication. Do not be reticent or embarrassed to share information. Be forthcoming about your medical history and the drugs and supplements you take, whether prescription, over-the-counter or even illicit. Your proper treatment and your safety depend on it.
Follow your doctor's preoperative and postoperative instructions. They are meant to make the procedure and your recovery easier for you.
Do not hesitate to ask questions about anything and everything that is not clear to you. Your oral and maxillofacial surgeon wants you to understand and be comfortable with the treatment you receive. By fulfilling your role and partnering with your oral and maxillofacial surgeon in your treatment, you promote the culture of safety and the delivery of quality care.