I remember when I first started as a nurse and learning about the intricacies of caring for patients when one of the nurses who was supervising me said about a particular task; ‘this is the way we do it round here, you might go to the ward next door and they do it slightly differently but ‘this is the way we do it round here’. This phrase has been used time and time again during my training and beyond. When I moved into intensive care, when I moved to another hospital … ‘this is the way we do it round here’.
People who study safety culture often say that it is ‘the way we behave when no one is watching’ – the things we do as routine, the things we do without thinking, the way we behave to one another because that’s how it is.
The definition of culture is ‘the ideas, beliefs, customs, and social behaviour of a particular people, ethnic group or age group in society’.
Anthropologists describe it as ‘the sum total of ways of living built up by a group of human beings and transmitted from one generation to another’ i.e. the way we do things round here.
Within the NHS there are multiple groups of people, multiple teams, multiple cultures; people who work in organisations with thousands of staff through to isolated individuals working in remote communities. Professions, teams and departments with formal customs and hierarchies that prevent people from challenging others. Professions, teams and departments that go out of their way to gather people together to hear from everyone no matter how disparate their views. Professions, teams and departments that all have their own ideas, beliefs, customs and behaviours.
If culture is a combination of ideas, beliefs, customs, and social behaviour of a particular people, ethnic or age group in society’ and ‘the way we do it round here… when no one is watching’ – what is a safety culture?
If safety is both a state where as few things as possible go wrong and a state where as much as possible goes right (Ref: Eric Hollnagel) then a safety culture is the mixture of the behaviours, decisions, beliefs, the way we do it found here, in order to make this happen.
A safety culture is therefore:
- one that is mindful for the potential for getting it wrong, for risk and harm, one that takes steps to prevent that and to minimise its effects if it does
- one that seeks to learn when things do go wrong or nearly go wrong; learn so that things can be changed to the system to the designs of what we do to intuitively help us get it right
- one that seeks to learn from the day to day and seeks to learn from when we get it right in order to replicate it, and seeks a way of optimising what we know we do well
This beautiful combination will as Eric Hollnagel and others suggest help us move the language from ‘one person’s job’ or a topic of ‘patient safety’ to helping people work safely. This is the task of policy makers, leaders, managers, clinicians – all of us.
At Sign up to Safety we believe that in order to do this we need a different way of working together. One where we are kind and respectful of each other. That we need to help people connect and create the relationships that are vital for safety; where people are able to speak out, and are listened to when they do. This culture needs to be fair and consistent both when things have gone wrong and when things have gone right; a ‘just culture’.
At Sign up to Safety we are therefore seeking to help everyone grow and nurture and achieve the ultimate safety culture:
a mind-set and a set of behaviours that become the very essence of what we do so that working safely is embedded into our beliefs, customs, social behaviour, ‘the way we do it round here’
Patient Safety Now 