The next top tip for safer surgery that I want to talk to you about is the importance of culture. Culture is commonly known as the way things are done around here. In this session we will discover why every practise should embrace culture and how this can improve patient safety.
So we know that workplace culture is the character and personality of an organisation. It's made up of the organization's leadership, values, traditions and beliefs and the behaviours and attitudes of the people in it. And we know that culture is subdivided into organisational and employee culture.
Organisational culture is how a practise treats its clients, patients, and each other. The foundation of excellent veterinary care is likely to be. The sorry, the foundation of veterinary practise culture is likely to be excellent veterinary care.
But to do this, many businesses have realised that making their staff priority is key. A healthy work environment is likely to lead to lower staff turnover, improved teamwork, raise morale and increase productivity and efficiency. The most successful organisational cultures are led from the top.
Time should be taken to identify the key cultural values, behaviours and goals within a practise, and these should be communicated, promoted, and embedded into all departments, including, and especially the recruitment process to ensure that new staff are like-minded and open to learning and improvement. Having recruited employees that are open to learning and improvement is important to welcome them and provide them with mentors who foster good culture. They should begin a constant onboarding process where core values are constantly referred to and kept alive.
We mustn't confuse culture with climate. I always think of climate. Of an organisation, a bit like the weather, if income drops, Drops, cutbacks are made, bonuses cancelled, redundancies made, benefits reduced, employees may feel despondent or resentful.
In this scenario, the culture has not changed, but the climate has. Leaders at all levels should be aware of this and and must also be aware that there might be varying climates within an overriding overriding culture. Psychological safety.
Is a culture of respect, trust and openness, where it's not risky to raise concerns and ideas. Team members feel confident that no one on the team will embarrass or punish anyone else for admitting a mistake, asking a question, or offering a new idea. When we experience stress at work, our brain triggers a flight, fright, or freeze response, and it shuts down our ability to think strategically and shifts our behaviour for reasonable and rational to primal and reactive.
The most common triggers of our stress response in practise include unrealistic workload, lack of respect, unfair treatment, not being heard or feeling or being unappreciated. So we know that there's various benefits of psychological safety. We know that it creates a spiralling effect with positive emotions and a far greater positive outlook by the team and the individual.
We know that it releases happy hormones such as serotonin, dopamine and oxytocin. Which are responsible for our positive emotions and enable our mind to broaden and improves our learning and retention. It improves resilience and persistence and improves our incognitive ability by 31%.
It's really easy to appreciate how important psychological safety is within the veterinary practise. So how do we build psychological safety? Well, we need to frame work as a learning problem.
We need everybody's brains and voices in the game. We need to acknowledge fallibility, and we need to model curiosity and ask lots of questions that get everybody's thoughts and voices in the game. When we look at the graph on the right hand side of this page, we can see that if we have low motivation and accountability and low psychological safety, we have apathy.
If we have low motivation and accountability. And high psychological safety, we find ourselves in the comfort zone. And if we have high motivation and accountability and no psychological safety, we find ourselves feeling very anxious.
Where we want to be is in the learning zone. That's where the magic happens, where we have high motivation, accountability and high psychological safety. Everybody knows the spine chilling, nauseating feeling when you realise you've made a mistake, irrespective of your professional experience.
The slow motion moment where the clippers roll off the table and smash onto the floor because you're rushing and you didn't put them back problem properly. Or the terrible realisation that you miscalculated the sedation you drew up and had just overdosed your patient. Head in your hands, you count the cost.
Panic rising, you know you need to fess up and tell somebody, but you're drowning in the fear that you'll be in big trouble, struck off, fired, or financially liable. A just culture considers wider systemic issues when things go wrong. Encouraging staff to be able to freely admit inadvertent error without fear of punishment, so that incidents can be investigated and the cause understood to guarantee safety can be improved.
It's the midpoint between a blame culture and a no blame culture. Just culture balances learning with accountability. A blame culture is in some ways a natural human reaction to an adverse event.
We seek to find out who caused the error and punish them so that it doesn't happen again. A nobling culture suggests that anything goes. We know that some situations are not acceptable and we need to draw a line in the sand.
A just culture seeks to improve seeks to move away from asking who caused the problem and asks why and what happened. Ensuring that a just culture is employed in practise means that if the clipper smash, the patient receives an overdose, or the worst thing that you think can happen, you know that you can share your experience in a non-judgmental and supportive environment without the fear of recrimination, and will have support from your team to work together to make suggestions for improvement. We know that employer just culture is about balancing learning with accountability.
We need to understand that very rarely do people seek to sabotage or perform recklessly or seriously violate the rules for personal gain. However, when they do, we must recognise a line in the sand, and those sorts of behaviours trigger a disciplinary action. Much more frequently, we know that people experience a lack of knowledge or skill, where they require, coaching, training or further education to ensure that they don't make mistakes.
Most frequently, what we see is honest mistakes made or systems failures with which we need to sit down and look at how we can prevent this happening again through systemic change. We need to move From blaming people to asking who was hurt, what they need, and whose obligation is it to meet that need. Apology is really essential in practise, being able to apologise in the right way at the right time is so so powerful.
It finds common human values, it restores balance, shows empathy, it reconnects and restores relationships. It elicits a positive physiological response and enhances early resolution. We know that when a person who has been harmed feels emotionally healed when he's acknowledged by the wrongdoer.
When we receive an apology, we no longer perceive the wrongdoer as a personal threat. Apology helps us move past our anger and prevents us from being stuck in the past and opens the door to forgiveness by allowing us to have empathy for the wrongdoer. Apology also benefits the receiver and the giver.
The debilitating effects of remorse and shame that we feel when we've hurt another poor person can eat away at us and until we become emotionally and and and until we become emotionally and physically ill. By apologising and taking responsibility for our actions, we help rid ourselves of esteem, robbing, self reproach and guilt. Apology has the power to humble even the most arrogant.
When we develop the courage to admit we are wrong and work past our resistance to apologising, we develop a deep sense of self-respect. Apologising helps us remain emotionally connected to our friends and loved ones. Knowing we have wronged someone may cause us to distance ourselves from that person.
But once we've apologised, we feel freer to be vulnerable and intimate with them again. And there's a little talked about benefit. Since apologising usually causes us to feel humiliated, it can also act as a deterrent, reminding us not to repeat the act.
When we apologise, we need to use the structure. It's not OK just to say I'm sorry. We need to say, why, because, and.
We need to say what we're sorry for. We need to accept and acknowledge that we got it wrong. And we need to show that we recognise the impact or the consequence of our action.
One way that we can do this is to establish a social contract. And this is an example of a social contract. We need to accept that there are only good people working here today.
Sometimes, however, we can get overloaded. Sometimes we're not our best selves. And if this happens, we're sorry.
If you let us know, we will deal with this by letting the person know. And because, like you, they're good people, they will do their best to correct it. So in this session we've talked about the importance of culture or the way things are done around here.
And we've examined a couple of tools that we can use to improve our culture, including just culture, an apology and a social contract. And by doing this, we know that we can improve patient safety.
