With more than 400,000 Americans dying each year from preventable medical harm and errors, the question remains whether patient safety is really a priority in healthcare. There has been little overall improvement (6.3 percent) in hospital performance since 2012, according to the Leapfrog Group's spring 2014 Hospital Safety Scores.
Now, the Joint Commission has charged the C-Suite with creating a real culture of safety with a new resource aiming its safety message at hospital leadership. The new Patient Safety Systems chapter is included in the 2015 Comprehensive Accreditation Manual being distributed to accredited U.S. hospitals. Hospital leaders often struggle with creating the top-down infrastructure needed to drive a safety culture. Hampering the effort: Typically responsibilities have been divvied among staff focusing individually on areas of quality improvement, patient safety or accreditation. When leadership does not manage patient safety and quality initiatives, between 75% and 80% of the projects fail, the manual says.
Many industries, such as mining and manufacturing, involve inherently dangerous lines of work, but the best companies attack safety with a vengeance and nearly eliminate preventable errors and accidents. Organizations in these industries put employee safety first at all times, and the same focus should be put on patient safety in healthcare. What can we learn?
- Patient safety must be part of hospital culture. Putting patient safety first requires healthcare organizations to commit time, resources, and energy. Hospitals should not have to put their daily operations on hold while they address patient safety issues. Rather, this focus should be part of their daily operations and an inherent part of their culture.
- Allow clinicians to speak freely about medical errors. Particularly in manufacturing, facilities that embrace Lean and Toyota Production, errors are seen as opportunities to improve processes and performance.
- Mandating protocols is not enough. When healthcare adopts Lean, checklists, and other manufacturing solutions, they often focus on process at the expense of the role of people. Toyota will tell you that Lean is about two pillars — "process" and "people." The process won't work without engaging people.
- Collaboration is key. Collaboration is a relatively new concept in healthcare, an industry that has traditionally valued professional autonomy. Certainly there are areas where collaboration is the norm — think of a well coordinated trauma team. But when it comes to broader challenges that require integrated solutions, we need new levels of collaboration.
- Engage staff. Front-line staff "own" safety in a manufacturing facility. The solutions need to meet their needs and goals. The same is true in healthcare.
- Build talent strategies around patient safety goals. Hospitals need to specifically define behaviors that support a culture of safety. For example, in the case of the surgical checklist, a flexible leadership style, sense of ownership among staff and teamwork are critical. The best hospitals include behavioral skills like collaboration in the selection and performance evaluation process of everyone on the team, including physicians.
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