HOVERTECH International

A Culture of Safety: Part 2

By: Cynthia Sylvia, D NURS, MSc, MA, RN, CWCN

Dear Caregiver,

My first blog introduced a topic that is of interest to all practitioners: a Culture of Safety. I hope you found it thought-provoking and perhaps had a discussion with your colleagues. This time, we are going to delve a bit deeper with a focus on reliability and how we as healthcare professionals can collaborate to strengthen our culture of safety.

In my initial blog, I posited that a commitment to reliability is fundamental to a Culture of Safety. Merriam-Webster defines reliability as ‘the extent to which an experiment, test, or measuring procedure yields the same results on repeated trials.’ You can also think of reliability as the quality of being trustworthy or performing consistently. A high reliability organization is underpinned by prevention and resilience, and being accountable is held in the highest regard. A systems approach to prevent and manage risk is routed in the individual’s commitment to reliability and being accountable for each action taken. 

The effectiveness of the systems approach hinges on the reliability of each action within the system. Systems that are constructed for prevention are proactive.  Being proactive in anticipation of error, as opposed to being reactive, is a major paradigm of high reliability organizations. The principles of being preoccupied with failure, reluctance to simplify interpretations, sensitivity to operations, commitment to resilience and deferring to expertise are all deeply ingrained within HROs (Oster and Braaten, 2016). Each of these principles are associated with both PIP and SPHM. Constantly being alert to the impact of single actions on the entire system heightens awareness. This constant vigilance is a paradigm change.   

Paying attention to the smallest of details can make the difference in quality of care (Nelson and Gordon, 2006). The overall purpose of initiatives such as PIP and SPHM impact quality of care by engaging staff with accountability to minimize risk within an environment where the probability of error is high. The reliability of the simple act of turning and repositioning patients is essential to the systems approach to PIP. The act may appear to be simple, but the evidence shows that due to a multiplicity of challenges, barriers exist that preclude turning and repositioning being performed as recommended, according to a customized plan of care (National Pressure Ulcer Advisory Panel et al., 2014). The ANA suggests the use of technology to facilitate SPHM in a way that is safe and encourages compliance with practice that is both reliable and accountable (ANA, 2013). 

Essential to professional practice is accountability. Basic nursing care is anything but basic; it’s practice based upon evidence that weaves together a complex system aimed at the maintenance and quality of health (Nelson and Gordon, 2006). Basic nursing care thrives in an environment that is designed for mitigation of risk, where evidence-based practice is enabled by intentional acts of prevention that minimize or reduce risk. Use of technology (such as the Q2Roller) to ensure the performance of evidence-based practice (such as turning and repositioning) according to a customized schedule is an example of being proactive. The use of technology has the potential to facilitate performance of preventive measures by minimizing associated challenges to care and thereby mitigating the risk of pressure injuries.  

Once again, I hope that you found this interesting and I look forward to sharing more on this topic with you next time. I challenge you to look a little closer at how your own well-being fits into the equation of the Culture of Safety.

Warm Regards,



  • American Nurses Association, 2013. Safe Patient Handling and Mobility: Interprofessional National Standards. Nursesbooks.org, Silver Spring, MD.
  • National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance, Haesler, E., 2014. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guidelines.
  • Nelson, S., Gordon, S., 2006. The Complexities of Care Nursing Reconsidered. Cornell University Press, Ithaca, NY.
  • Oster, C.A., Braaten, J.A., 2016. High Reliability Organizations. Indianapolis, IN.




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