Open organisational culture: what does it entail? Healthcare stakeholders reaching consensus by means of a Delphi technique

Abstract

ObjectivesOpen organisational culture in hospitals is important, yet it remains unclear what it entails other than its referral to ‘open communication’ in the context of patient safety. This study aims to identify the elements of an open hospital culture.MethodsIn this group consensus study with a Delphi technique, statements were constructed based on the existing patient safety literature and input of 11 healthcare professionals from different backgrounds. A final framework consisting of 36 statements was reviewed on inclusion and exclusion, in multiple rounds by 32 experts and professionals working in healthcare. The feedback was analysed and shared with the panel after the group reached consensus on statements (>70% agreement).ResultsThe procedure resulted in 37 statements representing tangible (ie, leadership, organisational structures and processes, communication systems, employee attitudes, training and development, and patient orientation) and intangible themes (ie, psychological safety, open communication, cohesion, power, blame and shame, morals and ethics, and support and trust). The culture themes’ teamwork and commitment were not specific for an open culture, contradicting the patient safety literature. Thereby, an open mind was shown to be a novel characteristic.ConclusionsOpen culture entails an open mind-set and attitude of professionals beyond the scope of patient safety in which there is mutual awareness of each other’s (un)conscious biases, focus on team relationships and professional well-being and a transparent system with supervisors/leaders being role models and patients being involved. Although it is generally acknowledged that microlevel social processes necessary to enact patient safety deserve more attention, research has largely emphasised system-level structures and processes. This study provides practical enablers for addressing system and microlevel social processes to work towards an open culture in and across teams.

Learning from the implementation of clinical empathy training: an explorative qualitative study in search of the barriers and facilitators

“…By placing the clerks in the role of medical coaches and giving them the task of briefing and debriefing patients before and after a consultation with a physician, the MedGezel initiative risked upgrading the status of the clerk and making the physician an object of potential criticism, which would conflict with a well-studied subject in medical culture, i.e., ‘saving face’ [ 34 ]. Physician culture dictates that openly criticizing each other is to be avoided, whereas an open culture is needed to be able to discuss each other’s performance [ 35 ]. Studies of Witman [ 36 ] and Scheepers [ 37 ] in the Netherlands revealed flaws in the achievement of an open culture.…”

To what extent is education for urinary catheter insertion and management offered to registered nurses in the United Kingdom?

“…The RCN 16 advise practice on a manikin until competent and Shehab, 9 42 promotes a learning environment where staff are provided opportunities to discuss practice scenarios utilizing a problem-solving approach without fear of blame or repercussions and supervisors and leaders are supportive of the learning environment. 43 Peter et al, 7 Norman et al, 6 analysis and accountability at organizational board level. 44 However, CAUTI has the potential to develop into catheter associated blood stream infection (CABSI), accounting for 20% of all cases of E. coli bacteraemia.…”

“…Research by West et al 41 identified a relationship between the extent of in‐house education offered to staff and patient mortality, therefore it is imperative that education is prioritized. An open organizational culture, such as a just culture, 42 promotes a learning environment where staff are provided opportunities to discuss practice scenarios utilizing a problem‐solving approach without fear of blame or repercussions and supervisors and leaders are supportive of the learning environment 43 …”

Key factors for effective implementation of healthcare workers support interventions after patient safety incidents in health organisations: a scoping review

“…The association between just culture and empathic and non-judgemental responses to PSIs has been clear 18 50 66 67. This is identified as a core condition for an open communication, and to establish positive relationships between peer supporters and HCWs, thereby enhancing programme adherence 67 68.…”

“…The association between just culture and empathic and non-judgemental responses to PSIs has been clear 18 50 66 67. This is identified as a core condition for an open communication, and to establish positive relationships between peer supporters and HCWs, thereby enhancing programme adherence 67 68. Namely, willingness to give support with empathy, leadership skills, reliability, being communicative and not being judgemental are essential elements for effective peer support 62.…”