CQI+ was developed through the lens of safety culture, so this concept is central to all activities required by CQI+. It is a licensee’s responsibility to not only ensure compliance of their pharmacy team with the CQI+ program requirements, but also to make efforts to foster a strong safety culture. It is critical for all pharmacy team members to truly understand and embrace safety culture when considering the broader CQI+ program requirements and how they apply within their own practices.
Safety culture in pharmacy relies on the pharmacy team having shared beliefs and values about patient safety. In safety culture, pharmacy team members share openly about
the quality of care provided and seek to learn from each other. Pharmacy team members also view practice incidents, close calls, and other concerns about patient safety as indicators of potential system weakness that may need to be addressed to improve safety.
The Health Quality Council of Alberta (HQCA) identifies three building blocks that are necessary to the success of safety culture:
A just culture enables a reporting and learning culture and, together, these components enable a strong safety culture. What is a just culture? A foundational component of a safety culture is a just culture, in which pharmacy team members are treated with respect and feel supported when something goes wrong or nearly goes wrong with patient care. Shared values, beliefs, and attitudes about safety guard against naming, shaming, and blaming people if something goes wrong with care delivery.
A foundational component of a safety culture is a just culture, in which pharmacy team members are treated with respect and feel supported when something goes wrong or nearly goes wrong with patient care. Shared values, beliefs, and attitudes about safety guard against naming, shaming, and blaming people if something goes wrong with care delivery.
This is important because individuals will feel less comfortable raising concerns or reporting an error when they fear backlash. As a result, the environment can become even more unsafe.
The Health Quality Council of Alberta outlines several behaviours associated with a just culture:
A just culture does not mean that individuals are not accountable for their actions. In fact, accountability is an important component of a just culture, and is essential in maintaining trust with patients after an incident has occurred. In a just culture, the actions of people involved when something goes wrong are assessed fairly. The process focuses on understanding why people acted the way they did by considering the context and contributing system factors while minimizing the influence of bias. Further, pharmacy team members are only held accountable for their actions. Accountability is always assessed in the context of the situation including contributing system factors.
Licensees should have a clear, transparent process in place to address the concept of accountability in a pharmacy team when a practice incident occurs. One tool that can help licensees achieve this is the Health Quality Council of Alberta’s Just Individual Assessment (JIA). Several additional resources are available to support decision-making at each of the steps identified in the JIA.
A reporting culture is an organizational climate in which people willingly report practice incidents and close calls. Reporting culture depends on a just culture where people feel safe and supported to raise concerns, and are confident that their feedback will be acted upon.
The pharmacy’s practice incident management platform should make it easy for pharmacy team members to report practice incidents and close calls, and it should be clear to reporters how their reports are used to improve a policy, procedure, or process.
A learning culture is the will of an organization to embrace change when it is needed. To know what is needed, an organization must strive to be informed. For a pharmacy team to have a strong learning culture, they must view the documentation and analysis of practice incidents and close calls as opportunities to learn and improve.
The pharmacy’s practice incident management platform is a critical tool to help pharmacy teams identify trends and insights from their practice incident and close call documentation.
Licensees should review HQCA’s Safety Culture Fact Sheet, which outlines barriers and facilitators of just, reporting, and learning cultures as components of a safety culture.
Licensees should work with their team to reflect on whether these features are present within their practice environment, and regularly take steps to enhance the safety culture.
Certain team members may take a specific interest in the pharmacy’s approach to safety and quality. Delegating components of the pharmacy’s CQI program to another regulated member on the pharmacy team is an excellent way to strengthen the safety culture by building engagement and encouraging collaboration amongst the pharmacy team. It is nonetheless important to remember that, while a pharmacy team may have leaders in their CQI program, safety culture is everyone’s responsibility.