How To Lead For Safety

There is nothing more important for healthcare providers than ensuring the safety of their patients and workforce. And, ACHE is committed to catalyzing healthcare leaders around safety.

We contacted three of our nation’s leading safety experts,  Tejal K. Gandhi, MD, CPPS, Chief Clinical and Safety Officer at Institute for Healthcare Improvement and President of its NPSF Lucian Leape Institute; John “Jack” Lynch III, FACHE, President/CEO of Main Line Health; and Doug Salvador, MD, Vice President of Medical Affairs at Baystate Health.  Each of them emphasized that the journey to a zero-harm environment begins with creating a safety culture.

“A culture of safety is the foundation for all work, from day-to-day operations and care to improvement initiatives in safety and beyond,” offers Gandhi.

But, culture often remains unchallenged because it’s seen as the way things have always been. According to Salvador, there is a mountain of evidence linking disrespectful and dismissive behavior by healthcare providers to the harm of patients. For this to change, Lynch stresses that there can be no compromise on quality of care and patient safety. It must be “embedded as a non-negotiable,” a core value for all healthcare organizations.

How To Get Started

“The most important first step is to measure the safety culture in your organization using a validated safety culture survey instrument,” says Salvador. This includes leadership, communication and interactions right at the front lines. Often, this is where cultural issues exist but are never talked about.

Gandhi points out that it is nearly impossible to sustain improvement without a clear vision for the future. Leaders should set the vision and model aligning behaviors to demonstrate an expectation of trust and respect across all levels of an organization. Lynch agrees. For an organization to lead for a culture of safety, it must also “ensure a supportive, inclusive and respectful environment so that each member speaks up for safety … and feels empowered to do so.”

ACHE, in partnership with the IHI/NPSF Lucian Leape Institute, launched Leading a Culture of Safety:  A Blueprint for Success, including an organizational self-assessment and best practices to help healthcare leaders build a sustainable culture of safety.  “Though creating a culture of safety is not easy, our new tool, provides a framework for leading an organization toward the ultimate goal of zero harm,” says Gandhi.

Common Obstacles Faced By Organizations

Lynch reminds healthcare leaders to expect challenges—and embrace them. These are essential to discovering an organization’s strengths and weaknesses, and how to make necessary improvements.  He suggests, “Leaders must be relied upon by all levels of staff … to address changes when they need to be made,” especially when focused on error prevention and safety.

It’s also important to remember changing organizational culture is an “ongoing journey,” indicates Gandhi. Salvador suggests leading these shifts in culture can be “extremely hard and often lonely.”  He emphasizes that support for creating a culture of safety has to come from the top because “setting new expectations for safe behaviors will be met with push-back from powerful places.”