We met Miguel Angel Máñez at the Security Master developed by the Spanish Ministry of Health and Social Policy and the Miguel Hernández University. We felt he provided a new –and very necessary- point of view respecting safety culture. That is why we asked to interview him and he has kindly answered.
Miguel Angel Máñez is an economist. He is currently the Deputy Manager of Economic and Human resources of the Alicante-Sant Joan Health Department. He is the author of
Salud con Cosas, a blog on healthcare management, since 2007. His areas of interest are leadership and clinical governance, innovation, social marketing applied to healthcare organizations, health 2.0 and change management. He has participated in courses and seminars on Internet and health, healthcare management and marketing; and he has also written articles in various media on these topics.
- S & H: Why, if we all agree on the "primun non nocere", in the ethical principle of nonmaleficence, are there difficulties for health professionals to take on the problems on patient safety? - M. A. M.: The custom and culture of each organization play an important role in how professionals behave. To generate a behaviour change is complex in humans and that is why incentives or rewards are often used to make this change not only fast but also durable. However, in the healthcare environment, the incentives associated with the implementation of a new culture based on patient safety are not very effective (in the case of economic incentives) and difficult to apply (the non-economic).
A clear comparison is the behaviour change in business environment, since to get a consumer buy a product is to create a purchase impulse that can produce positive results in just three minutes, but to change behaviour is something very long.
Finally, in the case of patient safety, the benefits are invisible to the professional, as they directly affect third parties, making the change difficult.
And counting on it, from your point of view, what are the strategies to succeed in introducing this culture? How can we “sell” it? First, we must show that there is a direct benefit for the professional. Without demonstrating that the change creates value for both professionals and their activities, we can not move forward. Social marketing techniques seek to modify behaviour based on an exchange, analyzing the attitudes of members of the organization to the proposed behaviour, and providing each professional skills and motivation both necessary to understand he can make that change.
We have to dissociate the "sale" of that culture of the monetary concept of the term "sale." Economic incentives only work in the short-run and, indeed, any change brought whit an economic incentive disappears when the incentive disappears. The design of incentives should be conducted in a manner that achieves a long-term change, appealing to professional values, beliefs and their abilities to overcome obstacles.
Moreover, a new culture implies that we must know exactly how the professionals of the organization are in order to detect the leaders, innovators and "early adopters" (in Rogers’s terminology) who are going to serve as engine and example. In addition, managers must act according to the new culture, to keep the professional look at their own bosses trying to implement a new way of doing things that they do not follow.
Finally, we need a consistent and innovative training base: workshops in the workplace, courses, training for managers of each unit, reminders, etc. Any support material is welcome, but also the originality and innovation will be appreciated to reach the professional’s attention.
Finally, what role do patients play in this topic? The patient plays a central role, because if healthcare organizations seek to generate a cultural change aimed at the improvement in security, is because it has been shown that there is improvement in patient care: more quality, more safety. Perhaps we have gone through a culture of wellness and safety time for the professional, sometimes forgetting, in the process design, that the ultimate objective of health services is to provide a range of patient cares.
One way that lately has been used to achieve these changes in the culture we are discussing is to use the patient as a means of transmitting the professional the need to make things differently. Within the
National Health Service (NHS) it has been much criticized, as there are professionals very reluctant to the idea of a patient requiring them to perform a task one way or another, but it is usually very effective. In fact, we are conducting in our center a project in social marketing and hand washing aimed to relate each type of marketing strategy with a change in professional’s behaviour.
Thank you very much for talking to us. Now it is time to reflect on what we have expressed and to work, more focused, to keep trying to create that culture of safety. Thank you very much
+ Info: a very interesting link, his class in the Patient Safety Master of the Spanish Ministry of Health and Social Policy and the Miguel Hernández University, where Miguel Angel Máñez develops some of the ideas reviewed in the interview. Posted by Safe and Healthy
English version by Erika Céspedes
A brief synopsis on Patient Safety, WHO/Europe 2010.
