4 ways healthcare leaders can create a culture of safety

Healthcare leaders--including board trustees--play a crucial role in creating a culture of safety at their organizations, but they don't always know where to begin.

Part of the problem is that board members are often more comfortable talking about and making financial decisions than they are overseeing quality and safety, Tejal Gandhi, M.D., pictured, president and CEO of the National Patient Safety Foundation, told FierceHealthcare during an exclusive interview.

"Safety is everyone's job, but leadership sets the tone. And by leaders, I'm not just talking about the CEO. I mean the chiefs, vice presidents and the board level. To me it's really important that boards are engaged on this," she says.

Gandhi says that organizations must educate board members about patient safety and give them the tools to build their competencies so they know what questions they should ask and not simply defer questions to clinical staff.

To help organizations educate board members and healthcare leaders, the National Patient Safety Foundation's Lucian Leape Institute and the American College of Healthcare Executives recently announced plans to develop a "playbook" to help healthcare organizations create and sustain a culture that will advance patient and workplace safety. The goal, Gandhi said in the announcement, is to provide senior healthcare leaders with a strategic and tactical plan, adding that working with ACHE will help healthcare leaders drive solutions.

The playbook is just in its beginning stages and isn't set for release until 2017. But in the meantime, Gandhi shared with us four patient safety strategies that healthcare leaders can implement now.

1. Listen to patient stories: Every board meeting could begin with a patient story, such as a near-miss or an adverse event. These stories, she says, can help board members focus on the people the organization serves--and not just the financials.

2. Look to other organizations for inspiration: Gandhi says many healthcare institutions have had success with patient safety initiatives. She points to the work by Vanderbilt University Medical Center in Nashville, Tennessee, to address disruptive and bullying behavior. "It's an important piece because if staff are afraid to speak up or constantly yelled at, you already have a pretty poor culture," she says. Virginia Mason Health System in Seattle has had success with its Respect for People initiative. And Cincinnati Children's Hospital conducts leadership huddles around quality and patient safety to make sure everyone talks about safety, she says.

3. Conduct leadership walkarounds. Gandhi started walkarounds at Brigham and Women's Hospital in Boston 14 years ago. The weekly rounds calls for the CEO to visit units and listen to their safety concerns. "It had a huge impact on our culture," she says. But these rounds can only be successful if the leaders actually make improvements based on what they learn. "If you ask about problems and nothing changes, the culture will become worse rather than better," she says.

4. Measure workforce safety. This aspect is a key component to a culture of safety but often is the least appreciated, she says. Leaders must work to prevent staff from physical and psychological harm. "If your workforce is burned out, if they experience disruptive behavior and suffer back injuries, it's impossible for them to deliver safe care," she says. "We really need to look at workforce safety as a condition of patient safety. If your burnout rates are sky high, I guarantee you are not delivering compassionate care to patients."

To learn more:
- read the NPSF-ACHE announcement

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