Safety Culture and Virtue

Over the past few weeks, I have wrestled with the idea of safety culture. Safety culture is itself a symptom of something that is difficult to pin down: virtue. The further I dug into safety culture in terms of virtue, the more questions arose. 

How can we tell if our organization has a culture of safety? 

How can we know that we are doing morally good work that will stand the test of time? 

And if virtue is missing, what should we do about it besides grieve and quit? 

One of my assumptions is that culture in patient safety involves defining what is good for patients and constraining our systems and behaviors to meet that standard. The Hippocratic Oath with the vow to do no harm was borne out of this thinking, and the Golden Rule to treat others as we would want to be treated has guided healthcare professionals for millennia.

Today, character traits like telling the truth, respecting others, protecting the vulnerable, and restraining blind violence are familiar examples of virtue that are spoken about readily in healthcare. But surely there are signs that our healthcare organizations are practicing what they preach and promoting safety culture, and I wanted to pin it down in specific terms. 

To create an effective environment for patient safety, everyone on the team must believe that doing wrong is abnormal and un-virtuous. For example, without virtue, healthcare providers would not wash their hands because hand washing is an inconvenience, and leaders are rarely watching. With virtue, diligent personnel will report a near miss simply because they want to save lives and treat people well. I think that is why so many books, articles, and consultants in patient safety emphasize the need for a culture of safety, but we must be specific about what is safe and what is dangerous to invoke that kind of culture. What exactly are we asking for?

So here is my definition: Virtue in healthcare is to value human life, and patient safety is the practical application of that virtue. All the noble efforts and personal sacrifices of healthcare professionals across the world come down to this truth because no one would do it unless human beings were valuable, and lives were worth saving.

Likewise, the ultimate failure that we work to avoid is an unexpected death. Why? Because human life is valuable.

Over the next few weeks I will share ten practical examples that will help you assess whether your organization possesses a robust safety culture, or whether the virtue of your team needs shoring up. I hope you find this discussion provocative enough to take a close look at your own teams and ask some important questions.