The Safety Culture Ladder (SCL) has its origins in the railway industry and the ideas have slowly but surely trickled down from there to other sectors. But it is mainly the 'tougher' sectors, such as construction and infrastructure, where people see the usefulness of the SCL. Unjustifiably so, because even in more 'soft' sectors such as healthcare, the SCL has its place, Sylvia Veereschild told us during the SCL event on 4 June.
Chairman of the day Veereschild talked the meeting on 4 June but also came up with his own thoughts on using the SCL in healthcare. 'I am a long-time patient myself and work in healthcare as a data exchange expert. I was not very familiar with the Safety Culture Ladder prior to this event. However, my husband works in construction and I had always noticed how serious he is about safety. For example, as the head superintendent of the construction site, he was then confronted with executives who came to watch and then did not put on a helmet or safety shoes. He could get really angry about that. At one company they welcome that sharp attitude, but elsewhere they say 'gosh, don't worry so much, it's our management though.' So safety is far from being everywhere top of mind.'
Learning from each other
In healthcare, Veereschild also sees that security in all its broad facets could be approached a bit better. 'From my sector, security is mainly about information security of medical data, for instance between hospitals and mental health institutions. But there is also insecurity on the work floor in healthcare. Are you allowed to report abuses, calamities or incidents? And what do
and them with that? There needs to be much more openness there. And it is precisely in that respect that the SCL can play a role because it is committed to culture change instead of waiting now for the Health and Youth Inspectorate to intervene when something goes wrong. In that context, I find it interesting to see how those 'harder' sectors like construction companies with all those men who don't talk much to each other are much further along than a 'soft' sector like healthcare. There, they talk much more about safety and already address each other on mutual behaviour more than in healthcare,' Veereschild laughingly charges. 'If healthcare looks more at those sectors, there is a lot to learn.'
Putting hierarchy aside
The Dutch healthcare landscape consists of organisations characterised by a high degree of hierarchy. Hospitals are a good example of this, explains Veereschild. 'Traditionally, the medical specialist says something, the nurse carries it out without contradiction. This is admittedly being worked on more and more now, including in training. This is also necessary: there will be more multidisciplinary teams and more cooperation for the patient. There is more understanding and recognition for each other's disciplines, improving the culture between them.' Another example: 'In district nursing, it is mainly the nurses who indicate to their managers that they want less control from above and more space to do their work.'
Dangerous consequences
A work culture that is not sufficiently committed to safety is a bad thing. 'In healthcare, it can even lead to the death of a patient. If cases are not reported, nothing can be learned from them either. Covering up mistakes does not work to make the working environment safer. And so the quality of care does not improve either. A mistake can happen anywhere. I cannot imagine that when someone goes to work in the morning, he or she does so to deliberately harm someone. If that has to be hidden from the Inspectorate or because of reputational damage to the institution concerned, that is not a good culture.'
Start with yourself
The first step to changing that culture is to look at where you are as an institution, Veereschild thinks. 'Perform a scan to find a starting point. Talk about it within your organisation. Just pretending nothing is wrong is the worst possible scenario. From the starting point, you can work further. The SCL is pre-eminently the appropriate tool for that.' But why don't many healthcare institutions already do this? 'I think that's partly to do with competition. Competition in healthcare is at least as strong as in sectors like construction. Institutions are constantly producing figures to prove their quality and ensure they have sufficient financial resources to provide care. Reputational damage is disastrous. And unfortunately, that includes not hanging out the dirty laundry. On top of that, this focus on numbers comes at the expense of the quality of care, and also safety on the shop floor.' Healthcare professionals themselves can do something to break this pattern, Veereschild believes. 'Just start in your own department. So start with yourself. Talk yourself about things you see but don't discuss, go to your colleague or supervisor with that.'
More open culture
Veereschild is hopeful that the safety culture in healthcare will become more open in the future. 'If we want to keep healthcare sustainable and affordable, we will have to step over our own shadow and seek more cooperation. You can already see this happening through various mergers and partnerships between organisations. This alone makes competition fade more into the background and makes them re-examine their work processes and a safe working culture come more to the surface. And with a good, pleasant and safe work culture, you also retain your staff. Especially in the current labour market, this is very important. For instance, you may wonder whether it is a smart idea that nurses working night shifts can no longer park their car for free and are thus forced to cycle through the city at night. That's not taking good care of your people. So a safe work culture improves safety, quality and retention of good people. Employees happy, managers happy and last but not least, patients happy!