CNA logoFostering a proactive culture of safety within a home care organization involves shifting the emphasis away from blaming individuals for errors and toward identifying, analyzing and correcting flawed processes or systems that may endanger clients. Fear of blame and retaliation can hinder safety and quality efforts. By recognizing and praising caregivers who advocate on behalf of clients and speak up regarding risky situations, administrators help reduce fear and clarify expectations about basic responsibilities and priorities.

A commitment to a culture of safety, in which caregivers are encouraged to question substandard practices and ask for assistance when in doubt, is essential to achieving a “just culture.” A just culture philosophy based upon positive, humane values supports an open, fair and learning-oriented workplace.

Other elements of a culture of safety include implementation of sound error-reduction and reporting measures, enhancement of communication skills, and ongoing staff training and education. Together, these strategies can help minimize risk and promote a more safe and client-centered environment.

Preventing Accidents and Injuries
The following strategies for direct caregivers can help avert errors and protect clients against injury. Instruct staff members to:

  • ask for clarification of assigned tasks and client requests if there is any ambiguity
  • never perform a task for which they are not trained or competent and to report any such requests to management
  • identify unsafe conditions in the home that could lead to accidents or illness, such as too-hot water, loose throw rugs or improper food storage
  • look for changes in the client’s condition that may require a different approach to care
  • actively listen to client and family concerns and seek assistance in evaluating the client when indicated
  • note unexplained bruises or other possible signs of abuse or neglect when providing personal care and relay these findings to a supervisor
  • continuously re-evaluate client preferences, physical limitations and cognitive impairments, in order to best meet client needs

Reporting Incidents and Near Misses
Prompt, thorough and candid reporting of incidents, hazards and near misses is essential to minimize the consequences of errors or accidents. The following measures can help enhance the reporting process:

  • Draft formal reporting criteria, detailing when to call 911, contact the client’s physician and family, and notify management of a problem.
  • Ensure that all caregivers understand what information must be reported, as well as how and when reports should be filed.
  • Train staff members in written and spoken communication skills, enabling them to clearly and concisely convey the urgency of a situation and describe the client’s condition.
  • Create documentation policies and procedures regarding accidents and safety concerns, specifying the information that must be recorded.

Training and Education
Staff training and education are at the heart of organizational culture. Instruction should be designed to help caregivers:

  • understand and implement applicable safety principles
  • recognize unsafe conditions and risk factors
  • efficiently and clearly convey client needs and situations to others
  • act immediately and appropriately following an injury or accident
  • correctly report and document accidents, safety concerns and near misses
  • disclose errors and near misses in order to learn from them and prevent recurrence

By aiming for a just culture and thereby promoting a safer, more responsive environment, home care providers can significantly enhance quality, customer satisfaction and employee morale, while reducing exposure to litigation and loss.

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