Components of Culture and the Learning System

The Organizational Culture is divided into multiple components which include Psychological Safety, Accountability, Teamwork and Communication, Negotiation, and an overlapping domain of Leadership.

  • Psychological Safety is best described as creating an environment where people feel comfortable and have opportunities to raise concerns or ask questions.
  • Accountability is being held to act in a safe and respectful manner and given the proper training and leadership support to do so.
  • Teamwork and Communication are core to developing a shared mental model and understanding, anticipating the needs and problems of our patients and healthcare delivery system, and then utilizing agreed-upon methods to manage these as well as conflict situations.
  • Negotiation is gaining genuine agreement on matters of importance to team members, patients, and families.
  • Leadership is an overlapping domain that is shared between both Culture and Learning Systems. Leadership is the fundamental act of facilitating and mentoring teamwork, improvement, respect, and psychological safety.

The Institute for Healthcare Improvement (IHI) has developed an extensive whitepaper that helps leaders across all levels in any healthcare organization focus their leadership efforts on delivering better patient care, reducing costs, and to improve the overall health of the population served.

IHI High-Impact Leadership
Improve Care, Improve the Health of Populations, and Reduce Costs
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IHI Trigger Tools
Trigger Tools provide an easy-to-use method for accurately identifying AEs (harm) and measuring the rate of AEs over time. Tracking AEs over time is a useful way to tell if changes being made are improving the safety of the care processes.
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IHI Global Trigger Tool Training Resources
The IHI Global Trigger Tool for Measuring Adverse Events provides instructions for training reviewers in this methodology and conducting a retrospective review of patient records using triggers to identify possible AEs.
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The Learning System is divided into multiple components which include Transparency, Reliability, Improvement and Measurement, Continuous Learning, and an overlapping domain of Leadership.

  • Transparency is the act of openly sharing data and other information concerning safe, respectful, and reliable care with staff and partners and families.
  • Reliability is a fundamental element of ensuring safe and reliable care and is centered around applying best evidence and minimizing non-patient specific variation with the goal of a failure-free operation over time. This effort of course requires continuous effort and attention.
  • Improvement and Measurement is focused on improving work processes and patient outcomes using standard improvement tools, including measurements over time.
  • Continuous Learning is a core element of any highly-reliable health system and requires regularly collecting and learning from defects and successes.

In order to become better learners, healthcare facilities must first assess and measure potential harm and their triggers. This can be helpful in creating voluntary reporting mechanisms and then sharing these learnings with frontline providers. The Institute for Healthcare Improvement (IHI) has developed a Trigger Tools resource that can help facilities assess for potential adverse events and medical errors.