Understanding the psychology behind staff safety culture.

Healthcare professionals possess a number of unique characteristics. Perhaps the most defining is their self-sacrifice. Their willingness to put the safety of their patients ahead of their own personal safety is probably second only to that of a parent, or more accurately a mother.

In the past this sacrifice was often mostly related to their time and emotional reserves. However, this self-sacrifice now includes more and more real physical and psychological issues – back injury, sharps injuries and infections.

Self-sacrifice and risk taking that was once considered to be a marker of one’s professional worth, now needs to be questioned, if not for one’s self, for the effect it can have on one’s family and children.

An alternative view basis of the unhealthy culture

I have formed an understanding based on my experience and subsequent research that an unhealthy culture can be explained, at least in part by 3 clinical factors and 2 management factors.

Clinical Factors

1. Denial

• Clinical staff know about many of the risks of infection with HIV and the various forms of hepatitis etc., but still decline to take appropriate precautions because these infections won’t happen to them.
• How much of this thinking is also seen with regard to their patients…… “those side effects and complications don’t happen to my patients”.

2. Unnecessary Self Sacrifice

• The majority of doctors and nurses still believe that when they make a personal sacrifice for the good of a patient, it somehow adds positively to their identity. Historically the sacrifice was usually their time (and that of their family’s). Now it involves serious injury and potentially fatal infections, but the old thinking survives and prospers
• In a discussion with the Harvard Professor who co-invented the Implicit Association Test, the only comparison that could be found was the actions of a parent (particular a mother), who would without hesitation put themselves at risk to protect their child or baby.

3. “Self-blame” or Blame worthy” culture

• This contributes to under reporting
• This obviates the need for staff to look for a safer alternative as they actually believe they will not suffer another injury so long as they are not rushed and don’t lose concentration
• This culture is in direct contradiction to the “No blame culture” being developed to improve patient safety
  

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Management Factors

Focus on patient Safety

For the reasons outlined above, clinical staff don’t complain about their own safety and therefore there is no incentive for Management to do so either. Almost of all of their attention is focused on patient safety. But for reasons outlined in the attached BMJ article this is probably having an effect opposite to the desired effect.

Costs of sharps injuries are basically hidden

• Firstly, up to 70% of sharps injuries are not reported by staff
• Corporate statistics are not kept
• Estimates of the cost of an uncomplicated injury
• An injury complicated by trauma to a digital artery, nerve or tendon, is estimated to be in the cost of $100,000 plus psychological impact to staff involved and lost productivity for the hospital
• The largest lawsuit was US$12.4 million
• The cost of medical therapy for a person infected with HIV &/or Hepatitis C is in the range of $100,000 annually

"We need to develop a single culture of safety for everyone” -Dr. Michael Sinnott. [1]

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