Enhancers
Good Communications
Acknowledging that one death or injury is one too many
Board Chairs who see the benefits
Board and Administration with a Passion for Safety (“Safety needs to be in the Hospitals DNA”)
Systems, systems, systems, e.g SBAR (Situation-Background-Assessment-Recommendation)
Investigations of sentinel events, root cause analysis, etc., etc.
Removing blame in reporting
Teamwork
Conflict Resolution Procedures (see AzAFP Statement)
Just environment
Concern and respect for employees
Concern and respect for patients
People with people skills
Humility
Compassion
Apologies
Patient involvement
Safety officers
Patient Safety Rounds
Executive WalkRounds™
Champions
RN, MD role-models
Non-punitive environment
Information sharing
An appreciation of cultural and linguistic competencies
EVERYONE including the cleaning staff, being involved in the safety culture
Listening well
Asking questions
Willingness to hear a different point of view
Using evidence based medicine
Using best practices
Focus on process not the person
Leverage technology
Credential and re-credential
A focus on transitions and transfers
Mini-safety courses

Diminishers

Poor communications (65% of serious events due to this)
Blame and Shame Culture
Disruptive behavior
Arrogance, big egos
Outsourcing (decreases communications)
“My way or the Highway” attitudes
Being overwhelmed with work
Lack of resources
Poor compensation and benefits
Lack of leadership at all levels
Treating colleagues poorly
Fatigue
Drugs
Alcohol
Undue bottom line focus
Litigation
Concern about self image
Lack of transparency, integrity candor
Organizational secrecy
Undue deference to authority
Legalistic and punitive-based approaches