Michelle Budd, D.D.S, Patient Safety Consultant, dentalcorp; Julian Perez, Senior Vice President, Risk Management & Compliance, dentalcorp
There are many definitions for culture, including “the systems of knowledge shared by a relatively large group of people.” Safety culture within an organization comprises the values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to—and the style and proficiency of—a health and safety program. In dentistry, as in healthcare in general, safety culture involves an unwavering commitment to the wellbeing of patients and team members.
Positive safety culture connects everyone around a common goal to measurably reduce near misses, injuries, and incidents; it goes beyond safety procedures and rules. Strong safety cultures elicit buy-in from team members. In an organization with such a culture, wellbeing and security become core values rather than afterthoughts.
Establishing and maintaining a positive safety culture doesn’t just happen overnight; it takes work, investment, and time. Involving the entire practice means listening to and valuing everyone’s contribution, and appreciating their perspective – from the principal dentist, to the office manager and treatment coordinator. It is only when safety becomes personal that cultural change happens.
Investing in safety
Building a safety culture is an investment and, when done well, the return on that investment is significant. Examples of how focusing on safety can lead to business success are numerous. Obviously, this is true in aviation; everyone wants to fly with the safest airline, on the safest model plane, from the safest manufacturer. When you think of Volvo, you think safe, and the Swedish automobile manufacturer has been cashing in on that reputation for decades. Healthcare is no different. Informed patients do their research and choose the hospital with the fewest adverse events. As more information becomes available to dental patients, they will do the same. Analysis of safety culture in medical organizations has been around longer than in dentistry, but positive ratings of dental practices is the future of our profession and must not be ignored.
Focusing on safety adds value in other less intuitive ways. In 1987, when Paul O’Neill took the helm of industrial giant Alcoa, he told shareholders that his top priority would be to make the company the safest in the industry. His reason? To improve the company’s profit. Paul O’Neill’s continued focus on safety rewarded the company and its shareholders handsomely. Within one year of his inaugural address to shareholders, Alcoa’s profits hit a record high. When he retired 13 years later, the company’s market capitalization was five times higher than when he started. This was not a coincidence. Paul O’Neill understood that safe companies must be well-managed companies. Safety cannot improve without high employee engagement, finely tuned processes, and excellent communication at every level of the organization. Paul O’Neill vastly improved Alcoa’s safety record and his employees adored him for it. In the process, he built a company that was better run, suffered less downtime and fostered tremendous teamwork.
Building a culture of safety takes work, but the concepts are simple. One of the key components of safety culture is the concept of just culture. Just culture is a culture of trust, learning and accountability, and is particularly relevant to how an organization responds when something goes wrong. Just culture minimizes the role of blaming and shaming when there is an incident. In his (2016) book “Just Culture,” author Sidney Dekker points out that there is a close tie between safety culture and people having the confidence to report when things go wrong. People only report when they know they'll be treated fairly. If a company’s impulse is to discipline and terminate people when things go wrong, errors are hidden and opportunities for learning and improvement are lost.
Reporting culture is a subset of just culture. To achieve a reporting culture, a company must cultivate an atmosphere where people have the confidence to report safety concerns, near misses, accidents and injuries without fear of blame. Employees must know that confidentiality will be maintained and that information they submit will be acted upon; otherwise, team members will decide there is no benefit in their reporting.
Developing or improving a dental practice’s safety culture involves influencing the safety-related attitudes and behaviors of all team members. Here are some tips on getting started:
1. Ensure that the commitment to safety begins with principal dentists/management
2. Involve the entire dental team in planning and implementing activities that promote safety
3. Identify and remove or contain hazards in the dental practice environment
4. Develop communication and feedback loops with all team members to verify whether system or process changes are actually improving safety
5. Openly discuss the importance of situational awareness
6. Promote individual accountability
Building a strong safety culture in your practice is no small feat – but it will certainly be worth your investment.
Assessing the Patient Safety Culture in Dentistry. Yansane A, Lee JH, Hebballi N, Obadan-Udoh E, White J, Walji M, Easterday C, Rindal B, Worley D, Kalenderian E. JDR Clin Trans Res. 2020 Oct;5(4):399-408. Available from https://pubmed.ncbi.nlm.nih.gov/31923373/
Infection Control in Practice. The Organization for Safety Asepsis and Prevention. March 2014. Available from https://cdn.ymaws.com/sites/osap.site-ym.com/resource/resmgr/ICIP_Issues/ICIP_MAR_2014-online.pdf
Safety Culture: Core Attributes of a World-Class Safety Culture. Available from https://safesitehq.com/wp-content/uploads/Safety-Culture-V01.pdf
Just Culture: Restoring Trust and Accountability in Your Organization. 3rd Ed. 2016. Sidney Dekker