Safety Culture: Seven Steps that Make it Easier for Work to Go Well

Kazue Nakajima, Professor and Director at University of Osaka Hospital

• Overview of a chapter in the forthcoming Incremental Safety Practices book, introducing a practical seven-step framework designed to translate resilient healthcare theory into everyday clinical practice. Utilizing a real-world case study on optimizing sleep medication prescriptions for elderly patients, the session demonstrates how to reconcile "work-as-imagined" with "work-as-done" to proactively enhance patient safety.
• Discussion of the challenge of organizational silos (the "takotsubo" metaphor) and the critical role of boundary-spanning multidisciplinary teams. How can healthcare organizations effectively empower these teams to capture the realities of everyday clinical work and understand performance adjustments and underlying ETTOs without falling into hindsight bias?
• Discussion of human performance variability and the Efficiency-Thoroughness Trade-Off (ETTO) principle. Rather than imposing stricter, difficult-to-follow rules, how can the "minimal action rule" be applied to redesign complex systems so that safe, correct behaviors require the least physical and cognitive effort from frontline staff?