Inside Duke Medicine

Values statement empowers all at DUHS

The incorporation of values across the health system strengthens employee empowerment.

The incorporation of values across the health system will strengthen employee empowerment and continue the evolution toward patient care delivered by expert teams working cohesively.

The September values roll-out complements the cultural change already encouraged through such training programs as Just Culture and TeamSTEPPS, said Karen Frush, MD, chief patient safety officer for DUHS.

Frush said that embracing our values is essential to build the new culture. “Our success will depend on the values we build into the work of our leaders and our team members.”

Historically, the culture of academic medical centers was focused on individual experts. But such patient-focused training programs as Just Culture and TeamSTEPPS demonstrate the value of a team-based approach. Additionally, rather than encouraging a “punitive culture” when something goes wrong, says Frush – the patient safety programs use training to focus on accountability and learning.

Training helps leaders become more effective and gives team members tools to speak up. They receive specific words and supportive language that make speaking up more comfortable.
The ongoing success of Just Culture has created a positive process to improve safety by reviewing not only systems issues, but also behavioral choices when problems arise, Frush said. Just Culture is built upon a value supportive system of accountability, in which healthcare leaders are accountable for the systems they design, and in turn, clinicians and employees are accountable for the choices they make within those systems.

In high performing teams, peers hold each other accountable for making safe choices, by pointing to their shared value of patient safety. The team-based approach, Dr. Frush said, is a part of the new values.
“We are transitioning to expert teams,” Frush said. “We are working to be completely focused on accountability through teamwork.” That means moving away from assigning blame to building supportive, team-focused accountability that promotes safety.

The new values will support these actions, Frush said, but the universal adoption of the values, like the principles of Just Culture, will take time to become a part of the fabric of the institution. The benefits of Just Culture, she said, are now becoming evident in the clinical environment.
For example, ensuring that every caregiver washes their hands before touching a patient is a simple but critical step, Frush said. Stopping a procedure because of a safety concern is more dramatic, but it should be welcomed in a team-focused care environment. And, now, this kind of safety goal is directly aligned with the core value of “Caring for patient, their loved ones, and each other” as well as the supporting values of excellence, safety and teamwork.

“We are working to create a belief that you can speak up if you have a safety concern and not be ridiculed or put down,” Frush said. “It happens when leaders create an environment of mutual respect. That’s simply the way we must work because we are taking care of people and each of one of us is responsible for their safety and well-being.”

Frush said the implementation of Just Culture and TeamSTEPPS provided numerous learning opportunities and is a similar model that can be applied to the demonstration of the values through the organization.
“For the values to become ingrained in our culture, it’s essential that we work together with a common commitment to the organization to be able to question whether decisions or actions we see in our daily work is consistent with our values,” Dr. Frush said. “That concept is the foundation for Just Culture, TeamSTEPPS and our values.”

View the complete pdf of the  Sept. 2011 Inside Duke Medicine or click through the articles online.