Sentara Norfolk General Hospital: accelerating improvement by focusing on building a culture of safety.

BACKGROUND: To accelerate progress in improving patient safety, Sentara Norfolk General Hospital (SNGH) supplemented its improvement programs with an initiative to strengthen its organizational culture of safety. CREATING A CULTURE OF SAFETY: SNGH established and intternalized behaviors in the organization that would result in safer and more reliable and productive human erformance. Four areas of focus were identified: (1) creating Behavior-Based Expectations (BBEs) for error prevention for all positions, (2) establishing Red Rules to focus employees on rules with the highest level of consequence and risk if not followed exactly, (3) develping a technically based Root Cause and Common Cause Analysis process, and (4) implementing an appproach to focus and simplify policies and procedures. KEYS TO SUCCESS: The senior leadership made the safety initiative the number-one priority; operational goals were prioritized to ensure the availability of time and resources for the safety initiative. A team of five operational leaders led implementation and ensured efffective communication across the organization. Medical staff provided support to the safety initiative; for example, it developed and implemented its own BBEs list. Finally, employees were engaged in all phases of the initiative. SNGH's largest challenge remains to continue to accelerate improvement while simultaneously holding gains previously made.