Improve Your ASC's Safety Culture

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Improve Your ASC's Safety Culture

Know the current standards and follow established best practices

In 2014, the Andrews Institute Ambulatory Surgery Center in Gulf Breeze, Florida, conducted its first annual safety culture survey. It asked the employees to rank the ASC's performance in areas including safety priority within the facility, safety as part of the ASC's ongoing agenda, accountability, issues corrected, teamwork and training.


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The results, says Barbara Holder, RN, the ASC's quality improvement, safety and infection control officer, were eye-opening. "Our employees rated us at 82.5 percent, which is the equivalent of a B- in my book. We really strive for excellence in our facility. When you work with world-renowned surgeons bringing in athletes from around the globe, that is not an acceptable grade. It told me we had some serious work to do."

That kind of attitude exemplifies the perspective ASCs should take when evaluating their safety culture, says Debra Yoder, RN, director of clinical services for Surgical Management Professionals (SMP), an ASC and surgical hospital management and development company in Sioux Falls, South Dakota.

"Our primary goal must be to always remain cognizant of what we are doing to maintain the safe surroundings for our patients," she says. "We must also make sure our ASCs, as places of employment, provide a safe culture for our staff and physicians."

The daughter and wife of firefighters, Mary Merrill, RN, director of nursing for the Endoscopy Center of Niagara in Niagara Falls, New York, says she views safety as one of her top responsibilities. "I was brought up and live in a culture of safety. You learn to expect the unexpected and never think something cannot happen."

Doing More, Doing Better

Improving safety culture must be an organization-wide effort, Yoder says, with ASC leadership setting the tone. Managers must be cognoscente of current standards and evidence-based practices intended to help ensure the delivery of care in the best possible manner.

"Carefully research and follow the Centers for Disease Control and Prevention's (CDC) infection control guidelines, the Association of periOperative Registered Nurses' (AORN) guidelines for nursing and clinical staff, the Association for the Advancement of Medical Instrumentation's (AAMA) sterilization standards and the American Society of PeriAnesthesia Nurses' (ASPN) standards on patient recovery," she says. "As long as we follow these and other established best practice guidelines and recommendations, we will help maintain that safety culture and create a safe environment for patients."

She has done the same for fire preparedness. "The fire department comes by for education and we put out an actual fire every October, which is National Fire Prevention Month. We even did an exercise where staff were challenged to close their eyes and try to find their way around the center. This helps simulate the experience of a smoky environment."

Yoder says ASCs eager to improve their safety culture will be best served by taking steps to remove barriers that might stand in the way of staff participation. "Leaders must make sure not to tolerate any bullying and harassing behaviors. Make sure your ASC has an open environment where staff feel free to voice concerns. If a staff member speaks up, hear them out and research their concern. Let them understand that you want them to be honest and come forward when there are questions or concerns."

Yoder recommends ASCs consider using the Agency for Healthcare Research and Quality's Ambulatory Surgery Center Survey on Patient Safety Culture to assess staff opinion about the culture of patient safety.

"That tool helps staff think about and answer questions concerning where they work, how they feel when they are at work and how they perceive patients are being treated," she says. "Try to get all of your staff and physician partners to fill it out. Valuable information can come from the survey."

Do not overlook the importance of physician involvement in safety efforts, Merrill says. "I have pushed our physicians to become even more involved and engaged. Everyone looks to them for leadership. We have a picture of one our doctors putting out a fire during an exercise. He was shocked about the weight of a fire extinguisher. Doctors need be fully trained and ready to go, just like staff."

Reaping the Rewards

A commitment to improving safety culture can deliver significant benefits, Yoder says. "When you create a safe environment, staff flourish and grow. Happy employees typically translate to happy surgeons and happy patients. When you embrace the importance of a safety culture, I think much of the work required comes naturally."

Merrill believes the efforts undertaken at Endoscopy Center of Niagara are having a positive impact that extends beyond the walls of the ASC. "Through our exercises, we are providing staff with a better appreciation of awareness and knowing your surroundings. Safety culture should be a way of living and not just contained to the center."

The improvement efforts undertaken at Andrews Institute ASC have paid off, Holder says. In August 2017, the ASC conducted its annual safety culture survey. The employee rating was more than 95 percent—an A+ to Holder.

"That was my personal goal," she says. "We have seen improvements in team building, morale and effectiveness of identifying and handling safety issues and a decrease in incidents. The employees feel they have a voice and they use it. That helps everyone."