Why It Matters
Change takes leadership from the top. But what do you do if it's not there? IHI's Don Goldmann, MD, advises a patient safety officer to manage up without carrying the CEO's water.
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Dear IHI: How Do I Get My CEO Engaged in Patient Safety?

By Don Goldmann | Thursday, April 20, 2017

I know IHI always says that strong leadership is essential to improve health care. What can I do if patient safety isn’t a top priority for my organization’s CEO? I know he has to worry about the bottom line, but when I try to get his support, he tells me patient safety is my job because it’s in my title. — FRUSTRATED PATIENT SAFETY OFFICER

Dear Frustrated PSO 

You’re right that this is a problem. If you don’t have the tangible support of your CEO, you can make gains, but it’s unlikely that your organization will become a patient safety exemplar. You could try to get your CEO engaged by running a guerilla operation and hoping that the results speak for themselves, but I don’t think it’s a good strategy to carry your CEO’s water.

But, it IS your job to manage up to the CEO and Board.

Every executive is different, but I might start off with a sit-down chat. Try this line: “Can I bring you a cup of coffee and, by the way, what’s your favorite pastry? I’d like just a few minutes to make sure we’re on the same page as organizational leaders.”

One time, I really messed up by not having the cup of coffee with a COO who didn’t seem to like my approach. Later, as he was leaving the organization, he said that one of his regrets was not taking the time to understand my point of view. So don’t assume that your CEO wouldn’t be open to such a conversation.

You can probably open with the usual pitch – harms that could be avoided, lives that could be saved, and costs that could have gone to the bottom line. But it’s not enough. At the end of your meeting, invite the CEO to join you and the CNO on Executive Walk Rounds.

I vividly recall inviting my CEO to join me on rounds. Following my instructions, the CEO asked staff and trainees, “Has anything happened in the past few days that made you feel you were not keeping your patients safe?” A senior resident immediately answered, “I feel unsafe every time I am on call at night. I have to cover two or three wards, and if there is a crisis on more than one of them, I won’t be able to respond, and the interns and patients won’t have my prompt support.” No one had realized that this was an issue, and the CEO promised to bring it up with the department chair, who also was surprised. Very soon, the wheels were in motion to have better senior support at night, and the CEO immediately saw how important his presence and personal interest had been.

There’s another lever you can use. Boards increasingly want to hear if their organization is reducing adverse events and improving patient safety. Many boards start the meeting with a patient narrative, which often relates to a harm that occurred in the hospital. The CEO won’t want to field these questions without your help, but he or she won’t want to look as though it’s someone else’s problem. It would be far better for the CEO to say that the two of you were addressing the problem to reduce the chances that it would happen again. You may find some useful information for working with boards in the IHI How-To Guide: Get Boards on Board.

Finally, the Joint Commission, ACGME, and other organizations that accredit organizations increasingly are asking for a private meeting with the CEO to be sure that they are both accountable and are serving as role models for promoting a culture of safety.

So now you have some arrows in your quiver. Just be sure the CEO isn’t on a diet.


Don Goldmann, MD

Chief Medical and Scientific Officer, IHI

Editor's Note: "Dear IHI" is an advice column in which IHI experts answer questions from health care change agents in the field. Leave your tips in the comments, and look for a new installment every other Thursday. Have a question for "Dear IHI"? Send it to info@ihi.org or on Twitter using the #DearIHI and @TheIHI.

Learn more in our upcoming program, Patient Safety Executive Development Program, March 1–7 in Boston, MA. 

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