Patient Safety and Leadership: Do You Walk the Walk?

How will I know when my hospital is safe?" To that question, many hospital CEOs would likely answer, "When I no longer have to call ahead to let staff know a family member is being admitted."Patient safety has been a strategic imperative in healthcare since our wake-up call- the Institute of Medicine (2000) report To Err Is Human: Building a Safer Health System, which suggested that as many as 98,000 people die each year as a result of medical errors. Yet medical errors today are still the third leading cause of death in the United States (Makary & Daniel, 2016). As key stakeholders, healthcare leaders have primary responsibility to solve this challenge.As with any problem, the first step toward a patient safety solution is admitting that there is a problem. Only then can it be defined and appropriate resources be committed to solve it. True success requires more than establishing a safety culture; the culture must also be sustainable beyond current leadership.Patient safety is a combination of people and processes, and both elements depend on leadership. In the aviation and nuclear industries, which are widely viewed as highly reliable and therefore safe, almost every analysis of accidents reveals a recurrent theme: the failure of leadership to promote a safety culture (Institute of Nuclear Power Operations, 2013).How can healthcare leaders avoid this pitfall? Simply budgeting dollars will not fix the issue; a thoughtful patient safety strategy requires leaders to engage on a personal level. Weekly patient safety rounds throughout a hospital, for example, not only give staff an opportunity to learn about safety concerns (with feedback to close the loop); they also allow senior leaders to leave the C-suite and be seen on the units. By rounding, leaders demonstrate to staff their commitment to the importance of patient safety. Similarly, daily 15-minute patient safety calls engage all leaders in a rapid situational safety review of the organization.Several elements contribute to a safety culture, including a commitment to safety, a nonpunitive approach to reporting errors and near misses, a common belief in the importance of a safety culture, teamwork, and a pervasive feeling of trust. Leadership plays a aacritical role in fostering each component.THE IMPORTANCE OF MEASUREMENTIn all performance improvement efforts, one must first measure the current status to be able to confirm that an intervention has resulted in improvement. In patient safety, this process often starts with a survey. At Northwell Health, a metropolitan New York health system with 21 acute care hospitals and more than 450 ambulatory sites, we administer the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture every 18 months.The following aspects of administering a safety culture survey are key:1. Key stakeholders must participate in the process. A multidisciplinary team must be involved in selecting the survey, rolling it out, reviewing the data, and formulating a strategy based on the results. At Northwell, all care team members are involved, and the marketing team publicizes the survey to increase participation.2. A validated tool, such as the AHRQ safety culture survey, is required (Jones, Skinner, Xu, Junfeng, & Mueller, 2009).3. The data must be analyzed all the way down to the individual unit level. Variation, the bane of quality and safety, can occur between departments in the same hospital as well as between hospitals. Analysis ofthe data on multiple levels is required where multiple cultures are in place.4. The results need to be shared with staff. At Northwell, managers are given the results for their areas of responsibility and then share them with frontline staff.5. Most important, a strategy based on the results must be implemented. A repeat survey 18 months later will not show improvement if team members feel leaders have not responded to their concerns. …