Why It Matters
The American College of Healthcare Executives (ACHE) and the Lucian Leape Institute (LLI) have partnered to develop a guide intended to assist leaders in creating, shaping, and sustaining the type of culture needed to advance patient and workforce safety efforts. Leading a Culture of Safety: A Blueprint for Success is designed to inspire, motivate, and inform you as you lead your organization on its journey to zero harm. The following is an excerpt from the Blueprint.
The journey toward patient and workforce safety requires vigilance and the highest level of dedication. Safety cannot be merely a strategic priority, but must be a core value that is woven into the fabric of our organizations. A culture of safety demands the involvement and commitment of the full health care team, from patients to clinicians to the entirety of the workforce.
However, an organization cannot be what its leader is not. It is both the obligation and the privilege of every health care CEO to create and represent a compelling vision for a culture of safety: a culture in which mistakes are acknowledged and lead to sustainable, positive change. These changes promote respectful and inclusive behaviors that become instinctive and serve as the behavioral norms for the organization. In this culture of health care the physical and psychological safety of patients and the workforce is both highly valued and ardently protected. This goal is one that needs constant energy and investment to achieve; these six domains are a place we can start:
Establish a compelling vision for safety — An organization’s vision reflects priorities that, when aligned with its mission, establish a strong foundation for the work of the organization. By embedding a vision for total patient and workforce safety within the organization, health care leaders demonstrate that safety is a core value.
Build trust, respect, and inclusion — Establishing trust, showing respect, and promoting inclusion — and demonstrating these principles throughout the organization and with patients and families — is essential to a leader’s ability to create and sustain a culture of safety. In order to achieve zero harm, leaders must ensure that their actions are consistent at all times and across all levels of the organization. Trust, respect, and inclusion are non-negotiable standards that must encompass the Board room, the C-suite, clinical departments, and the entire workforce.
Select, develop, and engage your Board — Governing Boards play a vital role in creating and maintaining safety cultures. CEOs are responsible for ensuring the education of their Board members on foundational safety science, including the importance of and processes for keeping patients and the workforce safe. Boards must ensure metrics that meaningfully assess organizational safety and a culture of safety are in place and systematically reviewed, analyzed, and the results acted upon.
Prioritize safety in the selection and development of leaders — It is the responsibility of the CEO, in collaboration with the Board, to include accountability for safety as part of the leadership development strategy for the organization. In addition, identifying physicians, nurses, and other clinical leaders as safety champions is key to closing the gap between administrative and clinical leadership development. Expectations for the design and delivery of relevant safety training for all executive and clinical leaders must be set by the CEO and subsequently spread throughout the organization.
Lead and reward a just culture — Leaders must possess a thorough understanding of the principles and behaviors of a just culture, and be committed to teaching and modeling them. Human error is and always will be a reality. In a just culture framework, the focus is on addressing systems issues that contribute to errors and harm. While clinicians and the workforce are held accountable for actively disregarding protocols and procedures, the reporting of errors, lapses, near-misses, and adverse events is encouraged. The workforce is supported when systems break down and errors occur. In a true just culture, all workforce members—both clinical and non-clinical—are empowered and unafraid to voice concerns about threats to patient and workforce safety.
Establish organizational behavior expectations — Senior leaders are responsible for establishing safety-mindfulness for all clinicians and the workforce and, perhaps even more importantly, modeling these behaviors and actions. These behaviors include, but are not limited to, transparency, effective teamwork, active communication, civility, and direct and timely feedback. These cultural commitments must be universally understood and apply equally to the entire workforce, regardless of rank, role, or department.
Learn more in the full report, Leading a Culture of Safety: A Blueprint for Success.