KK Women’s and Children’s Hospital (KKH) is a tertiary referral centre for Obstetrics, Gynaecology, Paediatrics and Neonatology, specialising in high-risk conditions for women and children in Singapore.
In 2016, Target Zero Harm by 2022 became a strategic priority for KKH. One of the factors identified to reduce the risk of patient harm is staff willingness to speak up. KKH needed an organisation-wide programme to strengthen their culture of safety, and overcome human factors barriers, to achieve their target of zero patient harm.
We recognised the need to strengthen our culture of safety and accountability with an aim to achieve our patient safety vision of ‘Target Zero Harm.’
Dr Alvin Chang
Quality, Safety and Risk Management
KK Women’s and Children’s Hospital
KK Women’s and Children’s Hospital (KKH) is Singapore’s leader in healthcare for women and children, and aims to deliver safe and reliable care for their patients.
Staff willingness to speak up when they are concerned that patient harm might be about to occur, can impact safe and reliable healthcare. The barriers to speaking up at KKH included the hierarchical nature of healthcare and a culture in Asia of respecting seniority and those with more experience. Less experienced staff feared speaking up might be perceived as disrespect and ignored, or seen as undermining the efficiency of the team.
The Speaking Up for Safety™ programme helped KKH overcome entrenched behaviours and improve their safety culture. The programme’s sustainable, organisation-wide framework empowers staff to support each other and raise concerns in a respectful, collegiate manner.
Speaking Up for Safety is delivered as a licensed train-the-trainer model, which enables the organisation to achieve culture change from within. KKH were able to build the internal capability to change their culture and train their staff, normalising respectful two-way communication that helps to prevent unintended patient harm.
The programme uses the Safety C.O.D.E., a graded model for standardising language when communicating concern. This model balances patient safety with respect, resulting in a culture where KKH staff are now comfortable to ‘check’ each other and welcome being ‘checked’ by others.
A dedicated Patient Safety team from KKH’s Quality, Safety and Risk Management Department worked with Cognitive Institute to implement the Speaking Up for Safety programme. Respected colleagues from multiple disciplines were selected and accredited by Cognitive Institute to deliver the Speaking Up for Safety seminar to staff.
The programme was delivered to all staff, and implementation began with senior leaders, then middle management, followed by frontline staff. Each department had a Patient Safety Lead, responsible for promoting and reinforcing safety awareness in their unit. This framework, collaboration and commitment to communication are key towards achieving zero harm.
The Speaking Up for Safety programme has helped to create a culture where people are more vocal about patient safety concerns – and empowering staff to speak up has helped us drive other patient safety initiatives.
Ms Pang Nguk Lan
Chief Risk Officer
KK Women’s and Children’s Hospital
The Safety C.O.D.E.™ is recognised by KKH staff as common language to respectfully raise issues with colleagues when they are concerned about patient safety. Every member of KKH staff from the most senior clinician to the most junior nurse use it as a guide to assert their concern when they feel the first conversation did not get the intended result.
A Patient Safety Culture Survey using the Agency for Healthcare Research and Quality (AHRQ) tool indicated an increase from 49.5% in 2010 to 81.2% in 2018 in staff willingness to speak up to prevent patient harm. KKH believe their speaking up culture has contributed to these outcomes.