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               1                                                        Go to the full guidance article
               2           Make a Plan: Culture of Safety: An Overview
                   Use the form below to organize an action plan to evaluate your organization's approach to a culture of safety. We have 
               3   included action recommendations as presented in the Healthcare Risk Control guidance article "Culture of Safety: An 
                   Overview," along with a few sample actionable steps. Please feel free to customize this form to meet the needs of your 
                   organization.
               4     Tasks Required               Priority             Assigned to           Deadline               Status               Comments
                   Identify specific       Use the drop-down  Identify the 
                   actions to address      list to indicate        individuals at your  Assign a date        Use the drop-down 
               5   each action             priority levels for     organization           for completing  list to indicate the       Provide further 
                   recommendation.         each  task.             responsible for        the required       status of the task.     detail on a task.
                   Insert or delete rows                           addressing the         actions. 
                   as needed.                                      task. 
               6   Action Recommendation: Communicate leadership support for a culture of safety.
                   Sample Task: 
                   Identify 
                   opportunities for 
               7   leaders to engage in 
                   organizational 
                   activities to 
                   strengthen the 
                   safety culture.
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           4    Tasks Required        Priority       Assigned to       Deadline         Status          Comments
              Sample Task: 
              Evaluate staff 
              perceptions of 
              leadership support 
           8  for patient safety 
              based on responses 
              to patient safety 
              culture surveys, and 
              address possible 
              shortcomings.
           9  Task: 
           10 Task: 
           11 Task: 
           12 Action Recommendation: Model expected behavior within a safety culture.
              Sample Task: 
              Participate in 
              leadership 
              walkrounds to 
           13 evaluate their 
              effectiveness in 
              soliciting staff input 
              about safety 
              concerns.
              Sample Task: 
              Recognize staff 
              members who 
              report near misses 
           14 and unsafe 
              conditions and 
              provide suggestions 
              for safety 
              improvements.
           15 Task: 
           16 Task:
           17 Task: 
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           4    Tasks Required        Priority       Assigned to       Deadline         Status          Comments
           18 Action Recommendation: Develop and enforce a code of conduct that defines appropriate behavior to 
              support a culture of safety and unacceptable behavior that can undermine it.
              Sample Task: 
              Review complaints 
              and events involving 
              unacceptable 
           19 behavior to 
              understand whether 
              intimidating or 
              unacceptable 
              behavior exists or 
              recurs.
              Sample Task: Use 
              the findings from 
              the review of 
              complaints and 
              events of 
              unacceptable 
              behavior to identify 
           20 opportunities to 
              improve staff 
              training, 
              interventional 
              strategies, and 
              other organizational 
              processes to 
              support the code of 
              conduct.
              Sample Task: Ensure 
              that the code of 
           21 conduct is 
              consistently 
              enforced.
           22 Task: 
           23 Task: 
           24 Task: 
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           4    Tasks Required        Priority       Assigned to       Deadline         Status          Comments
           25 Action Recommendation: Create an environment in which people can speak up about errors without fear of 
              punishment; use the information to identify the system flaws that contribute to mistakes.
              Sample Task: 
              Evaluate staff 
              perceptions of the 
              organization's 
           26 response to error 
              based on responses 
              to patient safety 
              culture surveys, and 
              address possible 
              shortcomings.
              Sample Task: 
              Describe safety 
              improvement 
           27 success stories as a 
              result of event 
              reports submitted 
              by staff.
           28 Task: 
           29 Task: 
           30 Task: 
           31 Action Recommendation: Apply a fair and consistent approach to evaluate the actions of staff involved in 
              patient safety incidents.
          © 2019 ECRI Institute