3 Foundational Elements for a Strong Safety Culture

November 12, 2015

Not-for-profit service provider agencies that want to reduce workers compensation costs can do so by building a culture of safety. The steps to building a workplace culture that is focused on safety begins with an organization’s leadership team making a commitment to safety and compelling the same commitment from all staff. Leadership can compel staff to care by clarifying why a culture of safety is important. By clarifying the purpose, staff will be more vested and engaged in the success of the program. After commitment to building a safety culture is established throughout the organization, the next step is building a foundation. The foundation for a culture of safety is made up of three key premises – optimal teamwork, a learning and growing environment and a focus on a predictive model versus a reactive model.

1.Optimal Teamwork 

Performance improvement projects start with good teamwork, but few organizations invest the resources to determine whether their team dynamics meet the mark. An optimal teamwork environment is one where staff members on all levels – from direct care workers to managers – work together with equal respect for one another and voice equally valued opinions in working to solve an issue.

Evidence of such an environment includes: frequent briefings and debriefings with all staff that involves equal participation from all participants; managers consulting direct caregivers or other line staff in investigating a reported concern not just to determine the facts or circumstances, but also to glean from those staff members their perspective of safety concerns; and staff’s report of high job satisfaction.  Assessment of team dynamics and team building may be needed in order to move forward in building a culture of safety.

2. Learning and Growing Environment
The second foundational element for building a culture of safety is a learning and growing environment.   Your team is most likely aware that they work in a high-risk environment. In realizing the risks, your team’s response to the risks may be to “knock on wood” or “cross fingers” in hopes there will be no incidents. But realizing and accepting that they work in a high-risk environment should not mean that the team accepts the risk of undesired outcomes, but instead will work to research and investigate each risk and develop approaches that will mitigate risk.

For example, direct care workers who work with clients who suffer from anxiety and exhibit aggressive behaviors without much warning may expect to be injured in the workplace. While the risk of being injured may exist, under a culture of safety, the team will study the risk in-depth and take approaches that will mitigate the risk of the staff member being injured. Although the number of risks is high, when risks are approached within a culture of safety, the team studies the risks and evaluates their processes and works to improve how the team provides care in order to reduce incidents and injury. Staff members who believe incidents in high-risk environments are inherent and cannot be mitigated are not committed to a culture-of-safety environment and can pose a threat to the organization’s mission.

In order to learn from incidents and accidents, your team must first make an important discernment. As part of the investigation, your team will discover that staff actions played a part in the incident. Your team will need to classify the actions as resulting from either: 1 – an error; 2 – poor judgement; or 3 – disregard for standards. Determining the differences among these three situations will guide your team’s response.

An error is easy to understand – the staff member knew what he or she was to do and intended to do what he or she was supposed to do, but instead had an accident. Two examples may be someone who misread a drug label or someone who slipped on a wet floor and fell. In these cases, your team will learn from these incidents by consoling the staff person and implementing a new protocol or practice to prevent reoccurrence.

In other situations, your team may determine that a staff member made a poor judgement – meaning the staff member knew what he or she should do but thought he or she had a reasonable justification not to do so. For example, the direct care worker understood the consumer was to be transferred with lift equipment, but thought the equipment would agitate the already upset patient so they performed a manual transfer instead. In this case, the staff member did not follow the consumer’s care plan and established safety standards. Most traditional organizations would implement disciplinary actions and would not investigate further. In a culture of safety, the response is different. The staff member simply did not think the risk of performing a manual transfer outweighed the benefit to the consumer. Most of the time, managers and supervisors are unaware of these occurrences of poor judgement unless an incident occurs, but these exercises in poor judgement occur often. Under a culture of safety, the team needs to respond to these occurrences with an organization-wide focus instead of a staff member-specific focus.

Determine if others are finding a reason not to follow a safety standard. When the team discovers that others are exercising the same poor judgement, an action plan for additional education may be required.  The team may consider implementing peer checks to ensure that the care team is mutually responsible for compliance with all safety standards.

Finally, your team may determine that a staff member’s actions demonstrated disregard with no justification – a lack of consideration for standards. This is reckless behavior and typically not coachable or correctable. It is not an incident that provides a learning or growth opportunity and should be referred appropriately for job performance follow-up.

3. Focus on a Predictive Model
Finally, the third and last foundational element for building a culture of safety is a change in focus from reactive to predictive modeling. Naturally, organizations must respond to actual incidents or accidents that occur. Their response involves investigating the circumstances that led to the event so that they can learn what they can do better in the future to potentially prevent future occurrences. These activities are described as the learning and growing element. Beyond learning from actual events and occurrences, in order to build a culture of safety, your team must change their focus to be more predictive or proactive in responding to safety risks.

For example, if a co-worker observes another direct care worker transfer a consumer without proper lift equipment, does the direct care worker respond differently whether the improper transfer results in consumer harm or not? With a predictive focus, failure to follow safety protocols is handled in the same manner, regardless of whether there is an adverse outcome or not. Teaching your team to identify risks or hazards in their work environment – like tripping hazards, water leaks or fraying carpet – and responding promptly to the risk with an immediate intervention is another way your team can exercise their predictive focus.

Staff members reporting potential risks or hazards such as co-worker fatigue or concerns about heavy workload also demonstrate your team’s proactive approach. These risks, when reported, should be met with mitigating interventions, just like a pool of water on the floor. Shifting your organization’s approach to a predictive model is possible, and the investment will reduce employee incidents and ultimately reduce costs that will positively impact your bottom line.

Building Accountability

After an organization makes a commitment to build a culture of safety and sets the three foundational elements in place, leadership must build accountability to ensure that the culture of safety continues to develop. Some key ways to build accountability include: detailing compliance with safety procedures in all job descriptions, reviewing safety procedures during onboarding of new employees, highlighting safety procedures during annual safety training and lastly, measuring compliance with these procedures during the 90-day and annual review process.

Measuring KPIs for Long-Term Success

Organizations that do the work to build a culture of safety will not only see a reduction in workers compensation costs, but also will witness evidence of other key performance indicators making the investment worthwhile. Organizations can evaluate the effectiveness of their culture of safety with performance data. An expected performance improvement measure is a decrease in workers compensation costs. A measure early on in the process is a decrease in time in reporting employee incidents. A delay in reporting – often referred to as lag time – may be indicative of employees’ apprehension to report or a supervisors’ lax responsiveness. Both of these situations improve in a culture of safety environment. Prompt reporting of employee injuries promotes rapid, appropriate treatment and an expedited return to duty. Another performance measure is the increased reporting of “good catches” – situations of potential hazards or errors that are reported so that the team can respond and address risks before there is an incident.  Finally, it’s wise to measure how employee satisfaction has improved through surveys and increased employee retention rates.

Assistant Vice President
The Graham Building
Philadelphia, PA, 19102
Shane Riccio
The Graham Building
Philadelphia, PA, 19102




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