PEER RESPONSES FOR Patient Outcomes and Sustainable Change

PEER RESPONSES FOR Patient Outcomes and Sustainable Change

Assessment Description

DQ 1

Assessment Description

Reflect on the “IHI Module PS 203: Pursuing Professional Accountability and a Just Culture.” As a future DNP leader describe what quantitative and qualitative data you could use to assess the culture of your practice site or organization. Explain how you can create, shape, and sustain a culture of safety for your site or organization using the six domains of a culture of safety. How will you inspire, motivate, and inform your organization on a journey of zero harm? Provide rationale and support for your explanation.


In my reflection of the “IHI Module PS 203: Pursuing Professional Accountability and a Just Culture.” I believe that as a future DNP leader, the quantitative data that I could use to assess the culture of my organization is the employee turnover rate. This data will reveal whether there is a positive or negative culture. A high turnover rate will imply there is a negative culture driving employees away while a low turnover rate will imply there is a positive culture keeping employees happy. The qualitative data that I could use to assess the culture of my organization includes job satisfaction, innovation, competitiveness, team orientation, and outcome orientation.

I can create, shape, and sustain a culture of safety for my organization using the six domains of a culture of safety. I will create a compelling vision for safety to ensure all stakeholders adopt practices aimed at supporting the culture of safety. Also, I will create an environment of trust, inclusion, and respect. This is vital in ensuring all stakeholders are actively engaged in the creation, adoption, and sustenance of a safety culture (Sexton et al., 2018).

I will inspire, motivate, and inform my organization on a journey of zero harm by ensuring all employees are directly involved in the process. First, I will have to educate and sensitize them on the significance of eliminating all risks that may cause harm to them at the workplace (Aloia, 2020). Thereafter, I will incorporate their input into creating strategies aimed at facilitating zero harm. This way, every individual will actively push to promote the strategies since they are personally invested in their success.


Aloia, T. A. (2020). Should zero harm be our goal? Annals of surgery271(1), 33-36.

Sexton, J. B., Adair, K. C., Leonard, M. W., Frankel, T. C., Proulx, J., Watson, S. R., … & Frankel, A. S. (2018). Providing feedback following Leadership WalkRounds is associated with better patient safety culture, higher employee engagement and lower burnout. BMJ quality & safety27(4), 261-270.


1. Thank you for the response above. You mentioned that you would involve the employees in the process. What are some specific ways that you could involve them in the process?

Bonnie Flores



2. Bonnie Flores

The module this week provided great insight into organizational culture. Creating a just culture is one where people feel safe reporting errors, near misses, and system issues (Institute for Healthcare Improvement IHI), 2020). As a leader, it is important to examine many different aspects, including quantitative data on how many errors occur. For example, quantitative data could be provided on how many medication or surgical site errors occur each week, month, and year. A qualitative survey could be conducted and examined about how the staff feels about reporting errors, how comfortable they feel, if they are worried about being fired, or if they feel that they work in an environment where it is safe or unsafe to report. Errors will happen; therefore, it is essential that all staff members are accountable for their part in errors so they can help create strategies to avoid future errors (IHI, 2020). Nearly 43 million medical errors occur annually; therefore, it is critical that healthcare organizations implement solutions to reduce the rates (Mahsoon & Dolansky, M., 2021). As a doctoral student and future doctoral nurse, it will be incumbent upon me to create an environment where all members feel comfortable discussing events that almost occurred, did happen, and observations of what is happening within the organization that makes it unsafe.

To create a safety culture, all organization members must work together and be mindful of potential safety issues, so everyone stays safe. The Institute for Healthcare Improvement (IHI) discussed the different strategies that organizations use for safety, from the pathological, where there is no interest in improving if they aren’t “caught” doing anything wrong, to the reactionary, where they respond to issues that arise, proactive practice anticipates potential harm and attempts to avoid it, but it is the generative culture where the organizational concentration from the top down is focused on safety, and that is how everyone works (IHI, 2020). When completing my annual safety training for my healthcare facility, the module focused on the generative culture and how safety is everyone’s responsibility. They did a good job ensuring that all employees receive the training, and there are many systems in place to ensure that, but they fall short of creating a culture where employees feel safe to speak up.

My facility is missing the psychological safety piece, where individuals feel safe speaking up and know they won’t be punished for either voicing concerns or making mistakes (IHI, 2020). Organizations where individuals felt safe to speak up correlated to lower fall and pressure injury rates (Han et al., 2020). In the study by Han et al. (2020), they found that facilities with cultures where reporting is non-punitive led to opportunities to help improve safety and errors rather than hiding them.

There are six components to ensuring a safety culture: vision, trust, respect, inclusion, engagement, leadership, just culture, and behavior expectation (IHI, 2020). As a future leader, it would be essential to create and sustain a safety culture using evidence-based practice methods, effective communication strategies, and building strong teams. Leaders model behaviors that they want all employees to emulate; therefore, it is important to have clear guidelines and expectations. They should have excellent communication skills, including listening, being approachable, and being transparent, so they can learn from their mistakes (IHI, 2020). Another vital aspect is setting clear expectations for all employees so they all know how to interact with other employees and have processes in place for when things don’t go as planned (IHI, 2020). As a doctoral leader, I will help motivate my organization on the journey to zero harm by engaging in respectful and honest conversations, ensuring that everyone understands the policies and feels comfortable sharing ideas on how to make the workplace safer. When people do a good job, I will encourage them and express my gratitude for their hard work. This leadership style will help facilitate open lines of communication and interdisciplinary practice that will engage employees to work as a team for improved patient safety (Mahsoon & Dolansky, M., 2021).


Han, Y., Kim, J. S., & Seo, Y. (2020). Cross-sectional study on patient safety culture, patient safety competency, and adverse events.  Western journal of nursing research,  42(1), 32-40.

Institute for Healthcare Improvement. (IHI). 2020). PS 203: Pursuing professional accountability and a just culture. Institute for Healthcare Improvement. Retrieved from

Mahsoon, A.N. & Dolansky, M. (2021). Safety culture and systems thinking for predicting safety competence and safety performance among registered nurses in Saudi Arabia: a cross-sectional study.  Journal of Research in Nursing26(1-2),19-32. doi: 10.1177/1744987120976171


3. Veronica Montemayor

Reflecting on the “IHI Module PS 203” this week helped me assess the just culture and the safety culture in my organization. As a future DNP leader, these reminders are essential to ensure our staff feels safe and has the materials they need to provide the best quality of care to the patients. Churruca et al. (2022) discussed how they used the Broken Windows Theory (BWT) and assessed the probability that the disorder may be an important construct to consider in hospitals, perpetuating a range of behaviors among staff with potential downstream effects on the quality and safety of care delivered to patients. Through a survey of staff across four hospitals, we identified significant differences between hospitals in staff’s perceptions of physical disorder that were corroborated by themes in qualitative open responses (Churruca et al., 2022). The authors used both quantitative and qualitative analysis for this study. In my organization, I can use quantitative data that reflects incidents where patients were harmed but preventable. The qualitative data may be used to assess the staff’s thoughts on the hospital’s safety culture. We conduct safety surveys every year for the staff and compare the data to the previous year to determine our focus.

To sustain a safety culture, leaders must communicate to reassure the staff that reporting events like near misses benefits future patients and their colleagues. I believe we have come a long way from that feeling that someone must be blamed for errors. Although some incidents may require disciplinary action, this should not be the automatic response. Moureaud et al. (2021) noted that the reporting culture is one that promotes, fosters, and rewards the reporting of errors and events across the spectrum of harm (none to significant harm); for this culture to develop, leaders must support department cultural norms. The authors further noted that these cultural norms include making employees feel psychologically safe to report errors and establishing a culture of error review and follow-up that complies with best practices. The cultural norms listed above are how I will inspire and motivate the staff in my organization toward a journey of zero harm.


Churruca, K., Ellis, L. A., Long, J. C., Pomare, C., Liauw, W., O’Donnell, C. M., & Braithwaite, J. (2022). An exploratory survey study of disorder and its association with safety culture in four hospitals.  BMC Health Services Research,  22(1), 1–10.

Moureaud, C., Hertig, J. B., & Weber, R. J. (2021). Guidelines for leading a safe medication error reporting culture.  Hospital Pharmacy,  56(5), 604–609.