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An Infusion of Trust: How Health Care Leaders Can Strengthen Safety Culture Within Their Organizations


In a fast-paced and often intense environment like health care, trust is paramount. Employees must have confidence and trust in their colleagues, leaders and organization as they work together to provide the best, safest care and patient experience, every day, every time. Likewise, patients must know they can trust their caregivers and the environment in which they receive care to make them better, not sicker. At the foundation of a safety culture in health care organizations, trust enables concerned employees to report unsafe events and near misses, and to identify opportunities for improvement.

A safety culture is the sum of what an organization is and what it does every day in the pursuit of zero harm for patients, staff and visitors. A strong safety culture is associated with positive patient outcomes, improved quality, patient satisfaction, staff engagement and retention, and financial strength.

The Joint Commission Center for Transforming Healthcare recognizes a safety culture as one of the three domains of change—along with Robust Process Improvement ® and Leadership Commitment to Zero Harm—that are necessary to achieve health care that is consistently excellent and safe.

Despite its critical role in the success of an organization, trust can be easily eroded. Employees who raise concerns that are not addressed can lose faith in their leadership’s willingness to change. At the same time, many organizations only provide high reliability training to staff within their quality department, leading to potential cynicism from employees who don’t feel empowered to share concerns or ideas. Organizations may also foster intimidating behaviors – such as reluctance or refusal to answer questions, condescending language and incivility – that create an environment of fear and anxiety, compromise communication between providers and undermine the teamwork that is necessary for excellent patient care. Toxic cultures within health care organizations are associated with harm to patients and employees, and they produce employee fatigue, disengagement, burnout, bullying and, in some extreme cases, workplace violence.

Disasters tend to exacerbate system weaknesses – and the COVID-19 pandemic has certainly brought the challenges faced by the health care system to the forefront. Trust, which is already a challenge in health care, has become more fragile for some organizations, due to the grief, stress and trauma constraints of this pandemic.

Three sets of actions that can help strengthen trust while organizations navigate the pandemic are:

Remember who you are. Leaders set the tone regarding the values, priorities and beliefs of an organization. While it is important to make the changes in operations necessary to respond to the pandemic, it is also important for leaders to connect the organization’s mission and values to how it responds to a crisis. Leaders need to model those values and the behaviors that build trust.

Communicate and Listen. Employees are looking for direction and clarity from leaders. Use every available medium—huddles, rounding, town halls, emails, newsletters, message boards, video, social media—to communicate and reinforce a sense of purpose and your understanding of what employees are going through. In addition, take the time to have one-on-one conversations with frontline staff as often as possible. Listen to their concerns and implement their good ideas, when feasible. It is important to communicate both what is happening and why it is happening.

Encourage, comfort and recognize. The speed, scale and impact of the COVID-19 pandemic is unprecedented. In addition to their responsibility to care for patients suffering from a highly infectious disease with a high mortality rate, many health care workers take care of families at home—or are separated from them to minimize the risk of transmission. They face financial uncertainty like the rest of the country. Their options to unwind and relax are limited. Leaders should line up resources now to help employees with grief and stress. Encourage your teams to use these services. If you can, provide support like transportation, meals and hotel rooms to care for employees who are caring for patients. Recognize achievement and celebrate positive outcomes.

This is no doubt a frightening time for the industry, but leaders have an opportunity to help and to empower their teams to help one another. Health care leaders can strengthen trust by finding ways to ease the burden on health care workers, and by communicating clearly and with compassion.

Speak with a High Reliability expert about strengthening your safety culture within your organization.

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Anne Marie Benedicto is Vice President at the Joint Commission Center for Transforming Healthcare