Organizational culture hazards

Like its popular predecessors, the book supplies a complete overview of hazard control, safety management, compliance, standards, and accreditation in the healthcare industry. This edition includes new information on leadership, performance improvement, risk management, organizational culture, behavioral safety, root cause analysis, and recent OSHA and Joint Commission Emergency Management requirements and regulatory changes. 

Krause is also the author of Leading with Safety, published in 2005, in which he writes of leadership, organizational sustaining systems, safety-enabling systems, organizational culture, and the working interface. The latter is described as the interaction of equipment, facilities, procedures, and the worker. Krause also says that a combination of these factors creates or eliminates exposures to hazards. Remember, Krause has been a major player in worker-focused behavior-based safety. And he now writes this ... 

One element of safety management is to look at the behavior of employees and the organizational culture. Everyone has a responsibility for safety and should participate in management system efforts. Modern organization safety has progressed from safety by compliance to a more appropriate concept of prevention by planning. Reliance on compliance could translate to after-the-fact hazard detection that does not identify organizational errors that are often the contributors to incidents [5]. 

The key is to develop attributes within the culture that keep hazards and associated risk visible. The strong organizational culture maintains a memory of the nature and scope of the hazards and associated risks. Refer to Appendix C, D, and E for further insights on culture traits, questions to ask, and potential impact. 

Finally, improvement efforts are most successful when the organizational culture is well understood by leaders. It is then possible to build upon favorable dimensions and undertake targeted improvement where the culture is weak. It is also possible for the administrative leadership to measure dimensions of the culture in tangible terms and report the results over time as a means of communicating the tone at the top, in the middle, and at the bedside in order to fulfill the board s responsibility to monitor the culture and oversee the emergence of safety hazards and ethical risks. 

Among the problems to which these leaders are blind are the very unpredictability of their own behavior and the resultant erosion in trust between leaders and followers. These developments are detectable with the Organizational Culture Diagnostic Instrument (see chapter 3) they show up as adverse changes in the OCDI dimensions of procedural justice (team members see the leaders behavior as unfair and untrustworthy), perceived organizational support (of team members by their leaders), and upward communication (by team members to their leaders about unsafe acts). The hazards and costs of cognitive bias thus often run deep in both the administrative and clinical chains of command in the healthcare organization. 

How will people act differently from the way they do now In terms of the dimensions of the Organizational Culture Diagnostic Instrument (OCDI), for example, the quality and frequency of both upward communication and approaching others will measurably improve. How will priorities be different Safety itself will move from a priority to a value, and the gathering of information on near misses and recurring hazards will command new importance and attention. 

Shein divides culture into three levels (figure 13.2) [188]. At the top are the surface-level cultural artifacts or routine aspects of everyday practice including hazard analyses and control algorithms and procedures. The second, middle level is the stated organizational rules, values, and practices that are used to create the top-level artifacts, such as safety policy, standards, and guidelines. At the lowest level is the often invisible but pervasive underlying deep cultural operating assumptions... 

In all of the model companies, safety is culture-driven. Senior management is personally and visibly involved and holds employees accountable for results. The senior executive staffs display by what they do that hazards management is a subject to be taken very seriously, a subject that is considered in performance measurement along with other organizational goals. 

For such an approach to be successful, it requires a good organizational safety culture and people participation and involvement. Because the real-time safety analysis is an integral part of BBS, using operational personnel involvement to identify hazards and risks is key to effective behavior-based safety a behavior-based process allows an organization or company to create and maintain a positive safety culture that continually reinforces safe behaviors over unsafe behaviors and ultimately results in a reduction of risk. 

To avoid hazard-related incidents resulting in serious injuries, human error potentials must be addressed at the cultural, organizational, management systems, design, and engineering levels, and with respect to the work methods prescribed. 

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