Responding to clinicians who fail to follow patient safety practices: perceptions of physicians, nurses, trainees, and patients.
Approach to Improving Safety
Setting of Care
Efforts to improve patient safety were initially built on the establishment of a no-blame philosophy, but recently experts have called for a just culture that balances systems-based thinking with personal accountability. This study surveyed physicians, nurses, medical students, and inpatients regarding attitudes toward public reporting and penalties for violations of basic safety protocols. The authors used scenarios involving hand hygiene, fall risk assessment, and preoperative time-outs since they are backed by strong evidence, easy to perform, and linked to important and common patient harms. Respondents endorsed feedback and penalties for clinicians that failed to follow these evidence-based practices. Health care professionals tended to favor punitive measures such as fines, suspensions, and firing, over public reporting. This may provide some insight into the power of public reporting to motivate change. An AHRQ WebM&M perspective discusses the organizational implementation of a just culture.