Changing a culture prone to medical error is one of the most difficult
obstacles to improving patient safety. In the traditional safety culture, blame
and judgment undermine reporting and systems improvement. A “fix-theproblem-not-the-blame” approach is at least articulated if not
operationalized in most healthcare organizations.
However, simply identifying risk management and quality improvement as a
no-blame system is not enough to change a culture deeply ingrained in
healthcare providers. The EIPS model may offer a way to change the
blame culture (see Figure 13.5). For example, in the story presented,
several clinical culture issues predisposed the unit to the error. Using
Reason’s model, the culture created holes that made the flow from error to
patient harm more likely, especially with the new employee orientation to
the clinical unit.
EI/Patient Safety (EIPS) Model.
In this model, good communication skills improve EI skills and
good EI skills improve communication. These two skill sets are in a positive
feedback loop. If communication skills are poor, EI abilities can improve
them. If communication is poor, safety is compromised, but as EI ability
improves communication, this negative influence is mitigated
via EI abilities.
Using the EIPS Model, diagram a patient safety procedure on your unit that
has an emotional or interpersonal “hole” in it. Describe in one paragraph
how one EI ability could be used to ameliorate that hole.
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