Proactive Patient Safety: Focusing on What Goes Right in the Perioperative Environment

Abstract

ObjectiveAdverse events in the perioperative environment, a potential risk to patients, may be mitigated by nurturing staff adaptability and resiliency. An activity called “One Safe Act” (OSA) was developed to capture and highlight proactive safety behaviors that staff use in their daily practice to promote safe patient care.MethodsOne Safe Act is conducted in-person in the perioperative environment by a facilitator. The facilitator gathers an ad hoc group of perioperative staff in the work unit. The activity is run as follows: staff introductions, purpose/instructions of the activity, participants self-reflect about their OSA (proactive safety behavior) and record it as free text in an online survey tool, the group debriefs with each person sharing their OSA, and the activity is concluded by summarizing behavioral themes. Each participant completed an attitudinal assessment to understand changes in safety culture perception.ResultsFrom December 2020 to July 2021, a total of 140 perioperative staff participated (21%, 140/657) over 28 OSA sessions with 136 (97%, 140/136) completing the attitudinal assessment. A total of 82% (112/136), 88% (120/136), and 90% (122/136) agreed that this activity would change their practices related to patient safety, improve their work unit’s ability to deliver safe care, and demonstrated their colleagues’ commitment to patient safety, respectively.ConclusionsThe OSA activity is participatory and collaborative to build shared, new knowledge, and community practices focused on proactive safety behaviors. The OSA activity achieved this goal with a near universal acceptance of the activity in promoting an intent to change personal practice and increasing engagement and commitment to safety culture.

Leveraging What Goes Right to Improve Perioperative Safety

“…Situational learning theory emphasizes learning in a community-based practice and is hypothesized to lead to more effective learning, particularly among inexperienced practitioners. 4 The authors 1 describe the One Safe Act (OSA) activity, which involves a trained facilitator assembling a convenience sample of multidisciplinary perioperative staff. In the study, the facilitator introduced the participants to the activity, by providing an example of a One Safe Act, which is a behavior that they use in their daily practice to promote individual and team-based safe patient care.…”

“…Given this limitation, the Safety-II framework was first described in 2015 by Danish psychologist Erik Hollnagel. 1,2 This conceptual framework was a paradigm shift in patient safety and proposed a comprehensive solution that recognizes the limitations of traditional approaches and emphasizes the importance of creating a culture of safety that proactively prevents harm from occurring. By focusing on what goes right, health care systems can develop a culture of safety that prioritizes patient safety and supports health care practitioners in their efforts to deliver high-quality care.…”