Safety cultures

To succumb to the past is to be a victim of the past. The need for increased vigilance with respect to error-avoidance in the operating room has risen as production pressure, complexity and fatigue have escalated. Safety-based systems of work have failed to infiltrate the cultural psyche of operating theatre personnel despite the continued occurrence of never events. ‘Below Ten Thousand’ is a simple example of a cultural change. It rises to the top of cultural practice, not because it is willed by executive leadership, but because clinicians working at the clinical interface choose safety as a foundational part of their practice. In short, clinicians choose to transcend the economic pressures placed upon the plying of their trade, and choose, instead, to be artisans of evidence-based excellence in their craft. Transcendence, a leap of faith in any tale, makes life so much better. Simply because the focus is shifted to positivity. To privilege the wellbeing of the patient is what we are all taught in our training. We call it ‘advocacy’. For some strange reason, we are taught less stringently to advocate on behalf of our own selves. Engaging in positive cultural change is advocating for both patient and self, and ‘Below Ten Thousand’ is such a simple example of such an act. If you can get this one small step right, then how many other things can we, together, achieve? Human factors, ergonomics, flowing systems of work, fatigue mitigation, deterrents to bullying, all of a sudden such things become possible, simply because we shine our lights on how human behaviour sustains our safety culture. If we make our safety culture sharper than our scalpels, the only thing we cut will be the inbuilt, inadvertent collateral harm which devastates both patients and clinical staff. Mission possible? The choice is yours to make.


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