Lead For and Commit to Safety

What can you, as a healthcare executive, do to aid your organization’s transformation into a high-reliability organization that delivers safer care and saves lives? Whether you’re a middle manager or a member of the C-suite, there is a role for you in building a culture of safety that leads toward zero harm care.

In The Safety Playbook: A Healthcare Leader's Guide to Building a High-Reliability Organization, John Byrnes, MD, and Susan Teman, RN, use a straightforward, no-jargon approach to show leaders how to embrace, communicate, model and reward safety as they guide the transformation into a high-reliability organization. Published by ACHE, The Safety Playbook dovetails perfectly with the partnership effort of ACHE and IHI to increase the focus on and commitment to safety by today’s healthcare executives.

Commit to Safety

According to Byrnes and Teman, “every level of a high-reliability organization needs to be aligned with safety as a core value.” From the board to physicians, to staff on the front-lines, each person is responsible for achieving zero patient harm. It starts at the top: with unwavering commitment by the trustees and executive leadership. This commitment is reflected in the inclusion of safety at the core of the strategic plan and in the dollars invested to train and motivate the entire organization.

Build a Just Culture

One of the foundations of a high-reliability organization is the establishment of a just culture—one that distinguishes between system and individual failures. A just culture is a culture of transparency and respect, where errors are reported and the first question asked is, “Why did this happen?” rather than, “Who did this?”

Byrnes and Teman promote the flattening of hierarchy as an essential step in the progress to a just culture, and they provide the “Call Me Bob” campaign as a case study. Taking a cue from the airline industry where the cockpit crew refer to each other by first names to encourage candid communication, Dr. Robert (Bob) Connors, president of Helen DeVos Children’s Hospital in Grand Rapids, Michigan, launched the “Call Me Bob” campaign to encourage a first-name-only approach among staff members and physicians. The goal of such initiatives is to eradicate the perception that speaking up to a senior staff member is equivalent to challenging authority. In a high reliability organization, it is essential that a nurse feels empowered to question a decision by a physician, and a junior staff member feels safe reporting an error.

Executive safety leadership actions

Some leadership techniques suggested by Byrnes and Teman to achieve a flattened hierarchy and build a just culture include:

• Practice executive rounds. Make a habit of regular visits to patient care units, initiating two-way communication and building approachability and trust with staff. During these visits share your commitment to the organization’s mission and values, in particular to safety, and gather important information from the front lines in patient care
• Sponsor and champion cause-analysis capabilities (find-and-fix exercises) and the resulting system improvements. Believe in the organization as a system of continual learning and improvement, and share that conviction with all members of the staff
• Communicate. Share safety data in a relatable manner; make the data transparent and tell stories to personalize it; share safety metrics within individual units

Learn more in The Safety Playbook: A Healthcare Leader's Guide to Building a High-Reliability Organization, available for purchase on ache.org.