Language makes a difference in building patient-safety culture at Toronto hospital
Number of patient safety reports increase when punitive words removed
Monday December 29, 2008 -- Natalie Miller
Tweaking a patient safety reporting system by making it easier to use and introducing more neutral language is having an impact on the culture at St. Joseph's Health Centre Toronto.

When the hospital introduced a web-based system for reporting compared to the paper-based model, it initially resulted in a 117 per cent increase in patient safety reports in its first year. However, when reports dropped the following year and staff suggested the system was "long, daunting and blaming," patient safety managers Nadine Agard and Lisa O'Drowsky saw the opportunity for change.

In addition to making the system more user-friendly by reducing the number of mandatory fields and pages, the hospital also changed the language in the system to be non-judgmental.

"Fear of reprisal or punishment is a well-documented cause of under-reporting," Agard and O'Drowsky say.

"To foster a culture that is open, transparent and blame-free, language with a punitive connotation was changed."

For example, the name of the system itself was changed from 'Incident Reporting System' to 'Safety Reporting System'. As well, the word ʽincidentʼ was changed to ʽsafety eventʼ throughout the database. When employees finish the report, they receive a message thanking them for their commitment to patient safety.

O'Drowsky attended a conference and reviewed various pieces of literature as part of her efforts to build a better reporting system.

"Of equal importance was the wisdom of the crowd," says Agard, noting "patient safety is everybody's business." By listening to staff feedback and altering the system, the hospital has seen positive changes in both the number of the reports completed and the culture.

"Definitely we've seen an increase in the number of reports," says Agard. Staff members are reporting near-misses as well now. "These are free lessons in patient safety and risk management," she says. "Our movement is creating a culture of safety. It has definitely improved."

Accreditation Canada noted in its April 2008 evaluation that patient safety was a notable area when talking to front-line staff, O'Drowsky says. As well, a patient safety survey conducted by the hospital this year showed a moderate increase in the perception of the culture.

"We're doing well at a unit level," Agard says. In addition, she notes, "Our (physicians) are dedicated towards reporting events and truly are really wanting to partner with us."

Read the first part of the article by clicking here.

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