Culture interventions

Hale, A.R., Guldenmund, F.W., van Loenhout, P.L.C.H. (2010) Evaluating safety management and culture interventions to improve safety Effective intervention strategies. Safety Science, 48(8), 1026-35. 

Managers should start practicing management by walkabout and visit their respective work areas. They must speak to their anployees, who are vital sources of information and are often overlooked in a culture intervention. Employees love to talk about safety and can tell more about the current state of safety in the plant than the audit will. The scheduled site visits and safety walkabouts should be written into the key performance areas of managers at all levels. This would be part of assigning safety responsibility, as discussed. 

Adams-Pizarro et al. (2008) Targeted culture intervention Across two years Hospitals participating in ED, ICU and OR collaboratives Hospital Survey on Patient Safety Culture OR teams improved on seven of 12 culture dimensions, ICU teams on three dimensions, and ED teams on one dimension... 

There is scarce evidence on the effectiveness of interventions aimed at improving safety culture. This lack of evidence is due to the fact that the effectiveness of safety culture interventions is hard to prove because, often, a combination of strategies is observed as having an impact without there being a clear and known relationship between each single intervention and a safety culture improvement... 

The implementation of a voluntary blameless reporting system is a deep cultural intervention in an organization that legitimizes transparency of system vulnerability, nurtures an alert field, and empowers front-line providers to expose risks. In turn, the front line learns to expect responses from managers at the blunt end to support the work of improvement. The few organizations in health care that have developed reporting systems believe that the effort is 75 percent social and only 25 percent technical (personal communication from Anne-Claire France, former director of the Center for Healthcare Improvement, Memorial Hermann Healthcare... 

Installing a blameless voluntary reporting system is a powerful cultural intervention to create transparency of errors and latent conditions so that learning can occur and zones or margins of safety can be identified. 

The patient has continued hypotension despite previous intervention. Continued hypoxia has led to mechanical ventilation. The patient s serum creatinine has risen to 6.8 mg/dl. Blood cultures reveal gram-positive cocci and lactose-negative oxidase-positive gram-negative rods. 

On the other hand, you rightly emphasised the problems that arise when dealing with patients whose value systems or cultural backgrounds are different. In Africa, one is frequently confronted by patients whose faith in sangomas, or witch doctors, is profound and whose language presents a barrier that requires the intervention of an interpreter and hence the loss of the interpersonal relationship that the holistic approach requires. Under these circumstances, reductionism is often the easiest answer to providing a good deal by Western standards. 

Access to health care can be defined in many ways, including by insurance status, number of physician visits in the last year, and treatment interventions once an individual is in the health care system. Furthermore, access can relate to whether the patient s health care is satisfactory, comprehensive, and meeting the overall needs of the patient from a social, cultural, spiritual, or other perspective. 

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