The development of a safety culture: a fanciful hope in the health care sector?

BJMO - volume 8, issue 3, july 2014

P. Coucke MD, PhD

Patient safety is a dimension of health care quality and a part of organisational safety culture. A deficit in safety culture represents an increased risk for ‘system’ errors. Errors in the health care sector are frequent and seriously harm a significant amount of patients. These errors must be seen as the end-product of accumulation of latent and active failures within the system and not systematically as the result of an individual mistake. The management of system failure to increase patient safety requires a cultural change. A long-lasting ‘blame and shame policy’ is seriously hampering this cultural change as under-registering of near misses and adverse events are the norm!

Organisational safety culture is multi-faceted and multidimensional. The main characteristics of the safety culture will be highlighted, as well as the methods to assess and detect a weakening safety culture. The health care sector faces an enormous challenge and the journey to better and safer care is a never ending road full of stumbling blocks hindering progression, especially in an environment where reduced financial potential will soon become the norm.

(BELG J MED ONCOL 2014;8(3):66–71)

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Operational Risk Management (ORM): the aviation safety model can be transposed into the medical sector

BJMO - volume 7, issue 5, december 2013

P. Coucke MD, PhD, M. Delgaudine , D. Boga , E. Lenaerts MD


Operational Risk Management is one of the most important attributes of High Reliability Organisations in the industrial sector. In this article it is questioned whether the Health Care Sector is a high reliability organisation. The application of safety models, widespread in the industrial sector is absolutely feasible in the medical sector. One should move from a shame-and-blame policy to a just culture. Pro-active search and reporting of unexpected events, incidents and accidents, coupled with root cause analysis and Deming’s principle of continuous plan-do-check-act is the only way to improve system safety and reduce errors. These industrial methodologies have been implemented with success in our radiotherapy department since 2009. From reporting of incidents we were able to move to steering continuous education and process management. Facing the high human and economical societal burden linked to lack of a robust operational risk management in the health care sector, it is an ethical duty for leaders to define new values and behaviours, both defining a new culture!

(BELG J MED ONCOL 2013;7(5):137–41)

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