Recently, the National Patient Safety Foundation released its report, “Free from Harm: Accelerating Patient Safety Improvement Fifteen Years After To Err is Human” which offers eight recommendations to lead to patient safety. A decade-and-a-half after the Institute of Medicine initially brought to the public’s attention the issue of medical errors, the NPSF is partnering with ACHE to urge healthcare executives to take a pledge to commit to creating a culture of safety for patients and providers.
Following this recent report, Tejal Gandhi, MD, NPSF’s president and CEO, breaks down how “there’s a variety of ways that executives can make their organizations safe for patients and providers… our report really highlights different strategies that organizations can take to drive towards that goal of safety.”
Leaders drive the culture in healthcare organizations
“One of the biggest messages from our report is really that leaders in organizations drive the culture in organizations,” explains Gandhi, “And we need to create a culture of safety in organizations where safety is a top priority.” For her, some indications of a healthy culture of safety mean creating a workplace environment where both clinicians and patients “feel comfortable” being vocal about any issues or concerns. But beyond being able to speak up, it’s crucial that they “feel that those concerns are being listened to and lead to actual improvements.”
“There are lots of ways for executives to measure this culture,” says Ghandi. In partnership with NPSF, the ACHE’s Patient Safety Self-Assessment allows executives to honestly analyze their current safety measures then prioritize targeted areas of improvement to implement a culture of safety, building from the six fundamental domains outlined in “Leading a Culture of Safety: A Blueprint for Success.”
By identifying and developing “interventions,” Ghandi says leaders can then “try to create that culture, but it really has to come from the Board to the C-suites all through the organization. Our expert panel felt that creating this culture change was critical.”
Safety extends across the care continuum
The patient experience extends beyond an intake center or an imaging lab. It can involve follow-up appointments, outpatient treatment, testing and so on, and Ghandi says healthcare leaders need to be thinking about delivering “safety across the entire care continuum.” She says, “as organizations are now becoming much more widespread and have facilities outside of hospitals, safety needs to be part of the conversation regardless of the setting.” In order to implement change across the board, having an up-to-date and clear understanding of current safety practices in every setting is a must in order to create a cultural shift in a proud, meaningful way that the patient and clinician can feel regardless of the site.
Why implementing workforce safety matters too
“We think workforce safety is actually a pre-condition of patient safety,” Ghandi explains. In working towards zero medical errors, healthcare leaders should not forget the importance of the safety of their own workforce too. This sets the tone, impacts clinicians’ mood, productivity and comfort levels, and has a residual effect on the ability to deliver the best care.
“Executives need to really focus on the safety of their workforce from a physical standpoint and a psychological standpoint,” says Ghandi, who adds that this can include mindfulness of issues like “burnout, stress, disruptive and bullying behavior…as well as the physical harms, workplace violence, etcetera, [they] need to be at the top of the attention of boards and senior leadership.”
To create a culture of safety, start by engaging patients at all levels
One of the report’s most significant takeaways is the essential need for leadership to value patient’s opinions, needs and concerns, and to engage with and learn from the real “users” of healthcare systems.
Ghandi says this means “really ensuring that patients are truly partners in their care, and having patients and the patient voice throughout the organization.”
This involvement can take different shapes and forms including most basically, shared decision-making between providers and patients.
“At the organizational level,” Ghandi stresses the significance of “having patients on boards, on quality committees, on quality improvement projects and even on things like root-cause analysis.” Overall, she believes that in order to create a culture of safety, “it’s really critical to have that patient partnership in all activities of your organization.”
ACHE’s John Buell interviewed Tejal Gandhi, MD, president and CEO, National Patient Safety Foundation, to learn healthcare executives can make organizations a safer place for clinicians to practice and patients to receive care.