Sustaining a Culture of Safety & Care Efficiency

By Martie L. MooreHot TopicsLeave a Comment

Untitled design (7)

In my travels around the country, I am continually fascinated by the differing styles of architecture I see, from the historical to the modern to the downright bizarre. Some of my favorites are the old Southern homes with the rows of columns standing sentry at the front. Beyond the imposing factor, these columns also double as support systems for impressive balconies and additional stories.

Just like the pillars used in architecture, there are pillars that support safety and care efficiency in healthcare. The three I like to focus on are culture of safety, care efficiency, and sustainability. These concepts and the domains that fall under them aren’t necessarily all that new to the healthcare environment, but that doesn’t make them any less of a priority.

Culture of Safety

In 2015, a group of researchers reviewed studies ranging from 1980 to January 2015 and found that the three domains of a culture of safety’s predominant influencers were teamwork, communication, and safety climate.1 Communication is something we may not always put a lot of thought into; after all, we’ve been talking most of our lives! But talking and communicating are not always the same thing. Interestingly enough, unless they’ve received specific training, the communication skills that they learned as a child are the same skills healthcare professionals end up bringing to the care settings. It’s cute and endearing when my granddaughters are frustrated and stomp their feet, but that same trait is not as endearing when demonstrated by adults, and certainly would create safety issues in the healthcare setting. We have a tendency to avoid those who are prone to acting out through adult temper tantrums such as withholding information, the silent treatment or triangulating, none of which foster good communication.

Communication is often seen as a “soft” cost, something that is nice to do but easily cut when budgets need trimming. Unfortunately, subpar communication ends up as a high cost to organizations when communication fails in a healthcare setting. A recent report by CRICO Strategies, a division of the Risk Management Foundation of the Harvard Medical Institutions, found that approximately one-third of malpractice cases involving nursing cite a breakdown in communication.2 Nearly half of the 23,000 malpractice cases reviewed in the study resulted in a high-severity injury, and a full third resulted in patient death.2 If critical information is not communicated properly, those knowledge gaps can result in significant patient harm

Care Efficiency

One of the difficulties of defining “efficiency” in healthcare is that it is a very relative term. Perspective has a great influence on what elements of healthcare delivery are valued, and efficiency can mean different things to different members of the healthcare team. For the sake of brevity, let’s focus on the professionalism that results in excellence of patient care as our prime directive.

Excellent patient care is another nebulous term that means many things to many people, but I like to think of it as anything that creates an effective workplace. In the effective workplace, things are self-explaining, self-ordering, self-regulating, and self-improving. An excellent example of this is visual systems. Visual systems assure that material and information have been organized to support getting work done safely and with predictability. Utilization of visual cuing also creates systems that reduce variation, creating standardization in practice guidelines which direct practitioners.


In 2010, Harvard Business Review accurately predicted that “most [leaders] know that how they respond to the challenge of sustainability will profoundly affect the competitiveness—and perhaps even the survival—of their organizations.”3 Because of this, resiliency has emerged as a new leadership competency, as leaders are tasked with creating organizations that bounce back in today’s complex environment.

Developing resiliency is not something that just happens. Conscious effort must be made to build and maintain resilient skill sets. Some of the steps you can take toward building resilience—both personal and organizational—include:4,5

  1. Building positive, nurturing professional relationships and networks
  2. Maintaining positivity
  3. Developing emotional insight
  4. Self care with focus on renewal
  5. Becoming more reflective

Overall, sustaining a culture of safety and care efficiency in a rapidly changing world requires emerging skills and competencies for healthcare leadership that focus on creating high reliability organizations through developing systems of safety along with organizational and individual resilience. Build these solid pillars, and the strength of your organization’s architecture can only grow.


  1. Sacks G, Shannon E, Dawes A, Rollo J, Nguyen D, Russell M, Ko C, Maggard-Gibbons M. Teamwork, communication and safety climate: a systematic review of interventions to improve surgical culture. BMJ Qual Saf. 2015; 0:1-10.
  2. Becker’s Infection Control & Clinical Quality. 5 things to know about communication errors, nurses and patient safety. Available at: Accessed February 5, 2016.
  3. Harvard Business Review. The Sustainability Imperative. Available at: Accessed February 4, 2016.
  4. Jackson D, Firtko A, Edenborough M. Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: a literature review. J Adv Nurs. 2001; 60(1): 1-9.
  5. Dyess A, Prestia A, Smith M. Support for Caring and Resiliency Among Successful Nurse Leaders. Nurs Admin Q. 2015; 39(2): 106-116
About the Author
Martie L. Moore

Martie L. Moore

Martie L. Moore, RN, MAOM, CPHQ, is the chief nursing officer at Medline. As CNO, Moore develops forward-thinking, solution-driven clinical programs, as well as new products and educational services. Prior to joining Medline, Martie was the chief nursing officer at Providence St. Vincent Medical Center in Portland, Ore. Under her leadership, Providence St. Vincent earned a third and fourth designation for Magnet.

View more posts by this author