If you’re truly serious about making your organization’s care safer, you sometimes need to feel uncomfortable.
At Virginia Mason, for example, regular meetings of the board of directors always include a patient in the room who describes his or her experience at our organization. The board requires that at least half of the stories they hear recount patients’ negative experiences.
While this causes some anxiety for our leaders and managers — there’s no way to feel good when someone looks you in the eye and describes how your organization disappointed or failed them — we know this degree of transparency is essential if there is to be continuous improvement. It’s like shining a bright light on opportunity.
Safety is the responsibility of every member of an organization’s team. This includes the board of directors.
Too often, however, board members feel inadequate when addressing safety issues or metrics and defer to the technical experts. This is a mistake. Ensuring a sustained focus on safety requires alignment from the board room to the organization’s front lines.
Leading a Culture of Safety: A Blueprint for Success, a report by a roundtable of experts convened by the IHI/NPSF Lucian Leape Institute and the American College of Healthcare Executives, reminds us that given the many pressing priorities in health care today “we must remember that the elimination of harm to our patients and workforce is our foremost moral and ethical obligation.”
I had the honor of serving as co-chair of the project that produced this report, which is designed to guide CEOs and other executive leaders as they assess and advance their organization’s culture of safety. The report provides high-level strategies and practical tactics for embedding a culture of safety throughout an organization. Key to success is an action plan that engages executive leadership and frontline employees, as well as the board of directors.
The report explains that:
In line with the CEO’s responsibilities, the board is responsible for making sure the correct oversight is in place, that quality and safety data are systematically reviewed, and that safety receives appropriate attention as a standing agenda item at all meetings. It is imperative that safety be a foundational factor in how health care boards make decisions so that patient and workforce safety culture is a sustainable focus for the organization.
Making Patient Safety a Priority
Safety must also be an organizational priority. Board discussions about safety and quality are every bit as important as conversations about finances. Quality and safety metrics should be a standing feature on the board of directors’ monthly dashboard. Board members should understand safety science and be able to interpret metrics in order to evaluate where and how the organization is progressing or falling short.
Across the American health care system, we have more information and evidence than ever about how to provide appropriate, high-quality care, and keep patients safe. System flaws are now widely recognized as causes of medical error and there’s a wealth of research about human factors and adverse events.
Strong leadership is essential for continuing and sustainable improvements in patient safety. At Virginia Mason, for example, board members who comprise the Quality Oversight Committee must review and approve all resolutions to red-level patient safety alerts developed by managers and other team leaders. About 10 percent of these recommended resolutions are rejected by the committee and sent back to managers for further refinement, with the goal of preventing the safety issue from recurring.
Leading a Culture of Safety: A Blueprint for Success points out that the board’s support of the CEO allows his or her focus on quality and safety “to cascade to leadership and, ultimately, throughout all levels of the organization.”
We have no business talking about quality if we cannot keep our patients safe. Safety is the foundation for quality. Quality comes from a relentless focus on improving all aspects of care — from service to outcomes to safety — at every touch point for every patient.
Gary S. Kaplan, MD, is chairman and CEO of Virginia Mason Health System in Seattle and immediate past chair of the IHI Board of Directors. He is also chair of the IHI/NPSF Lucian Leape Institute and will be part of a panel discussion about board engagement at this year’s Lucian Leape Institute Forum & Keynote Dinner (Sept. 28, 2017).
Safety is a featured track at the 2017 National Forum on Quality Improvement in Health Care this December 10-13, 2017, in Orlando Florida.