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The catalyst for patient safety emphasis and the importance of culture

The fifty-year period from 1950 to 2000 could reasonably be considered to be a golden age for medical science. During this period there were remarkable developments, such as CAT scans, MRI, ultrasound, a wide range of antibiotics, the development of intensive care units, organ transplantation and effective chemotherapy just to mention a few.

It seemed to be a golden age not paralleled at any previous time in history and as a consequence, bred expectations of better outcomes. However this euphoria was somewhat tempered by the Institute of Medicine's report in 1999 'To Err is Human', which estimated that up to one million people were injured and 98,000 died as a result of medical error in the United States.

This paved the way for more complicated and systematic studies and these results were even more disturbing with estimates of premature deaths to be more than 400,000. To put it in a slightly different perspective it would be the same as three 747 planes crashing each day. If that were to occur then the airline industry would almost certainly be finished or at the very least, all 747's removed from service. 

But the healthcare industry has simply been left to soldier on.

A strong recommendation was to develop a culture of safety, but this has not been a simple or easy task. The International Health Institute made recommendations to facilitate a culture of safety changes for improvement, though these recommendations may be considered to be aspirational rather than routine in many hospitals.

At times, it's not difficult to get a feeling of the culture of a hospital. Some years ago I visited St Thomas Hospital in London and was impressed by how staff and patients interacted in a positive way. I asked the CEO what the key strategies were and was informed that the change to positive culture resulted from all senior managers, clinical and administrative staff including finance spent a day a week out of their offices and on the wards talking to staff and patients. They then better understood the issues facing staff and patients.

Culture is undoubtedly difficult to measure and change. However, hospital boards, senior administrators and clinical leads are the keys to ensuring that there is good corporate governance that in turn leads to good culture. This is potentially the most important of the accreditation standards.

If you have implemented systems or programs within your organisation to influence culture, submit an abstract to present in the Culture & Collaboration section of our Patient Safety & Quality Care Symposium.

The Langford Oration, named in honour of the Royal Australasian College of Medical Adminstrators' (RACMA) Foundation President, the late Dr Sam Langford, is delivered by a distinguished person during the Conferment Ceremony. At the 2019 RACMA Conference, the speaker was Emeritus Professor Villis Marshall, who chose to discuss the topic of patient safety.