In early 2013, when rounding at a 180-bed long-term care facility, the consultant asked Kari, the care associate, how she would transfer a well-known resident, Mr. S, from wheelchair to bed. Mr. S requires maximum assistance, which means that he is able to do 25% or less of the work required for the transfer. Mr. S needs maximal support in the transfer. He can bear very little weight when standing and generally requires a two-person, mechanically assisted transfer. Kari paused briefly in response to the questions, and then spoke with certainty: “I would use the lift.” Upon further exploration, Kari explained that a coach was available to help with residents who met certain mobility (immobility) criteria. Kari said that she had participated in care enough times with the mobility coach and Mr. S that she was perfectly comfortable performing the task safely. This is an example of a culture of safety, in which safety is the overriding factor in making choices about tasks in the healthcare setting.

A culture of safety is at the heart of a safe patient handling and mobility program. The challenge to healthcare workers and other stakeholders is that
there is widespread misunderstanding about the structure and process necessary for a meaningful program. Introduction of technology, training, policies, and procedures is a great first step, but does not guarantee a culture of safety. The challenge is to transform a program into a culture of safety.

A number of factors affect the ability for a culture of safety to emerge from the necessary structure. For example, consider Julie Lavezzo and Ryan Rodriguez at Marin General Hospital in northern California. In a recent publication (Lavezzo & Rodriguez, 2013), these authors explain that, despite appropriate SPHM structure and improvement in loss history/injury data, they felt there were opportunities to improve the overall culture of safety. A humanistic component was introduced which transformed the program. A follow-up study further suggested that this addition improved satisfaction of the healthcare recipient, and deepened the integration of the SPHM program into the desired patient-care culture of the organization.

Most research suggests that employers and healthcare workers must partner to establish a culture of safety that encompasses the organization’s core values and behaviors. The value of administrative support cannot be overlooked as facilities seek sustained attitude and behavior change over time. For example, consider Carys Price at Christiana Hospital in Wilmington, Delaware. Ms. Price explains that the partnership between stakeholders at Christiana Hospital illustrates the successes that can be achieved by offering real-life, practical SPHM practices that meet the organization’s economic needs as well as core values. At Christiana, SPHM is integrated into every service line and recognized as a key initiative facility-wide by discussing, communicating, and presenting the topic of SPHM (Price, 2012).

Further, in an environment of competing interests, the value of SPHM must be recognized from a diverse economic and humanistic perspective. In both of the preceding examples, the SPHM program became a culture because the element of safety was integrated into every discipline and unit. The impact of a safety initiative that influences the goals and objectives of healthcare organizations today is essential. A SPHM program will truly be successful only when the program transforms into a culture of safety.

What follows are selected ideas and insights on implementing the SPHM standard on establishing a culture of safety. They are organized by the sets and subsets of the standards that are required by any facility: one specific to your organization as an employer, the other to your facility’s interprofessional
healthcare workers. Here we include ideas for developing a written statement outlining the organization’s commitment to a culture of safety, supported by appropriate staffing levels, communication, collaboration, reporting, and a process to identify and refuse to participate in care that threatens the health, safety, or well-being of the healthcare worker or healthcare recipient. (See the sample right to refuse policy and procedure in Appendix A.) The goal of this standard is to set the foundation from which the paradigm shift springs.