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These practices include (1) balancing the tension between production efficiency and reliability (safety), (2) creating and sustaining trust throughout the organization, (3) actively managing the process of change, (4) involving workers in decision making pertaining to work design and work flow, and (5) using knowledge management practices to establish the organization as a “learning organization.” These five management practices, which are essential to keeping patients safe, are not applied consistently in the work environments of nurses.
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These changes require leadership capable of transforming not just a physical environment, but also the beliefs and practices of nurses and other health care workers providing care in that environment and those in the HCO who establish the policies and practices that shape the environment-the individuals who constitute the management of the organization.īehavioral and organizational research on work and workforce effectiveness, health services research, studies of organizational disasters and their evolution, and studies of high-reliability organizations (see Chapter 1) have identified management practices that are consistently associated with successful implementation of change initiatives and achievement of safety in spite of high risk for error. Creating work environments for nurses that are most conducive to patient safety will require fundamental changes throughout many health care organizations (HCOs)-in the ways work is designed and personnel are deployed, and how the very culture of the organization understands and acts on the science of safety.