LEADERS SET THE TONE!

How can EMS leaders, already weighed down with projects and deadlines, find time to work on safety culture?  Or maybe the question is, “How can they NOT find the time?”  Good leaders understand how defining the vision, helping their crews support it, creating urgency, and removing barriers will move their team to a safer experience.

DISCUSSION OF THE TOPIC.

Leaders at the EMS agency scratched their heads in puzzlement and frustration.  The investigation of a serious clinical error identified significant process failures that led to a patient's death.  They also found patterns of behavior by front-line crews that contributed to the error.  They hired good people, trained them well, utilized the best equipment, and implemented progressive protocols.  So how could this happen?

Further investigation revealed that middle managers had allowed crews to take shortcuts and workarounds, bypassing established protocols.  The managers hoped to keep everyone “happy.” As long as things got done, no harm no foul--right? The shortcuts meant some performance metrics were improving, reflecting well on the managers. But as time passed, the shortcuts were normalized and became hardwired into agency practices. Acceptance of workarounds became part of its culture, ultimately leading to unsafe practices that caused the patient's death.

Patient harm in healthcare—including EMS-- happens every day.  Clinical errors can have many causes, and no event is the same.  Leaders need to encourage clinicians to recognize and report errors; crews can’t be afraid to report a mistake for fear of punitive actions.  This culture shift requires leaders who are actively engaged in promoting safe care, not just relying on staff to do the right things.   While unfortunate, errors shouldn’t be a surprise. A strong safety culture promotes efforts to find, investigate and learn from the unfortunate events that happen.

EMS has made significant strides in provider safety. However, many leaders haven’t made similar progress with patient safety in the clinical setting.  The reasons for this difference include lack of awareness of clinical risks; assuming somebody else (the medical director?) should ensure patient safety; or assuming the crews alone can support patient safety.   The culture pivot to patient safety requires specific leadership action within an organization, including steps to address the silos that separate clinical and workforce safety; one is not more important than the other. The key components of a strong safety culture can address both.