Safety culture milestone matrix

Six domains, each with six milestones in implementing a safety culture

Table 1. Domains and milestones on the journey to a safety culture.
Domain Milestone-1 Milestone-2 Milestone-3 Milestone-4 Milestone-5 Milestone-6
Vision Develop vision for safety and zero harm Complete and review regular culture of safety surveys Conduct training to build understanding and enthusiasm for vision among workforce Clearly communicate vision to patients and the public Benchmark progress with other organizations Innovate and exceed benchmark organizations
Trust, Respect, and Inclusion Provide education and training on respect, diversity, and inclusion Implement workforce safety programs, addressing both physical and psychological safety Encourage, recognize, and reward reporting Implement communication and resolution programs Develop and share patient and provider compacts Participate in full transparency with the public around harm events and action plans for improvement
Board Engagement Invest in resources for Board education Board completes regular self-assessments for safety and culture competencies Include clinical and safety expertise on all Boards and committees Include a patient/family representative on all Boards and committees Include Board members on rounds and in cross-organizational and external learning opportunities Bring patients to the board to tell their stories
Leadership Development Define organizational leadership competencies Define processes for leadership development at all levels Provide continuing education opportunities in safety science and culture Develop systems for training, coaching, and mentoring current and prospective leaders Provide opportunities for cross-departmental training Provide opportunities for learning from outside organizations and industries
Just Culture Develop just culture policy and align across systems and departments Educate Board, leadership, and workforce Utilize just culture principles in all event reviews and decisions Develop metrics for just culture and hold workforce accountable Treat gaps in culture as adverse events Involve the media to explain errors, data, and decisions to the public
Behavior Expetations Define organization-wide required processes and expected behaviors Define organizational response to disrespectful or disruptive behavior Encourage open reporting and safety discussions and provide transparent feedback Hold all leaders and workforce accountable for organization-wide expected behaviors Recognize and reward workforce engaging in defined safety behaviors Engage patients in all team activities and communication processes
References:
  1. Fleming M, Wentzell N. Patient safety culture improvement tool: development and guidelines for use. Healthcare Quarterly 2008; 11 (3 Spec No):10-15. (pdf:11pp)