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Only 50% of radiology employees always report safety concerns. Here's why—and 3 ways to do better.

July 17, 2018

    Staff reporting of safety concerns is critical to maintaining an imaging department that is safe for patients and employees. Frontline imaging staff are often in the best position to identify potential safety issues—but how often do they report these concerns?

    A recent study published by the Radiological Society of North America found only 50% of surveyed radiology employees reported that they "always speak up" about safety concerns. Meanwhile, 37% of the respondents said they speak up "most of the time," 10% reported speaking up "sometimes," and 2% reported "rarely speaking up." When the researchers asked respondents why they opted not to speak up about a safety concern, respondents' most cited reason was a "high reporting threshold"—these employees did not want to report unless they were sure they were correct. Other barriers to reporting included "reluctance to challenge someone in authority," "fear of disrespect," and "lack of listening."

    These survey responses highlight how important imaging leadership and a strong departmental culture are to safety event reporting and patient safety. With that in mind, here are three key strategies to improve the reporting culture at your organization:

    1. Implement a safety stop system

    To lower the reporting threshold, consider a safety stop system. One option we heard about in our recent research is the "CUS" tool, which stands for concerning, uneasy, or a safety issue. Staff members are trained to both say "CUS" as soon as they notice a safety issue and to stop when someone else says it. This provides staff with a standard, quick response when they want to report, which can make it easier for all staff to speak up. Below we have listed some key elements of safety stop programs.

    2. Consider adopting 'Just Culture'

    While a safety stop system can help combat a high reporting threshold, it is important to address other barriers to reporting, such as "reluctance to challenge someone in authority" and "fear of disrespect." The common theme here is the fear of immediate punitive action. To create an environment that encourages reporting, programs should consider adopting "Just Culture." At its core, this initiative encourages programs to evaluate safety incidents to determine what type of behavioral risk led to the incident and then choose an appropriate response.

    Importantly, "Just Culture" stipulates that programs should analyze the processes and procedures that allow human error to lead to a safety event before considering punitive action. And if staff understand that they won't immediately face disciplinary action for reporting an event, they may be more likely to report safety concerns. One imaging program we spoke with saw a 33% increase in reported safety events after implementing "Just Culture," demonstrating just how powerful lowering this barrier can be.

    3. Provide leadership training on communication, staff management

    Implementing a new program or changing a departmental culture can be a difficult task for imaging leaders, especially for those with a large span-of-control or who oversee multiple sites of care. But strong management and communications skills are critical components to combat "lack of listening" and 'reluctance to challenge someone in authority," two additional barriers to reporting highlighted in the study.

    To help your imaging managers develop these skills, the Imaging Performance Partnership created the Imaging Executive Development Program—an online, work-at-your-own-pace learning resource for imaging leaders at all levels. Within this program, we have modules and resources on a number of topics including improving communication, managing change, and persuading others.

    For those seeking additional research on imaging leader development, join us at our 2018 Imaging Performance Partnership National Meeting. We'll be presenting our new research, Retaining and Growing Radiology Talent, which includes best practices on preparing future leaders and improving leadership communication.


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