In­tegrity in lead­er­ship, gov­er­nance crit­i­cal to es­tab­lish and sus­tain a cul­ture of safety

Modern Healthcare - - COMMENT - By Charles D. Stokes In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? modernhealth­care.com/op-ed. View guide­lines at Send drafts to As­sis­tant Man­ag­ing Edi­tor David May dmay@modernhealth­care.com. at

In­tegrity car­ries spe­cial mean­ing in health­care en­vi­ron­ments. Hos­pi­tal and health sys­tem ex­ec­u­tives are called to make high-im­pact de­ci­sions ev­ery day—none more crit­i­cal than those in­volv­ing the de­liv­ery of ac­ces­si­ble, er­ror-free and ev­i­dence-based care.

From this priv­i­leged po­si­tion of trust, we serve the health­care needs of en­tire pop­u­la­tions, of­ten when those in the com­mu­nity are at their most vul­ner­a­ble. The in­di­vid­u­als and com­mu­ni­ties we serve rely on in­tegrity in lead­er­ship to en­sure they re­ceive care sup­ported by a cul­ture of safety that per­me­ates the en­tire or­ga­ni­za­tion.

None­the­less, pa­tient safety re­mains a pub­lic health is­sue in the U.S. health­care de­liv­ery sys­tem. Far too many deaths still oc­cur from med­i­cal er­rors, which, ac­cord­ing to a 2016 Johns Hop­kins Medicine study, are now the third-lead­ing cause of death for Amer­i­cans, num­ber­ing more than 250,000 each year. Fur­ther­more, 1 in 10 pa­tients de­vel­ops a hos­pi­tal-ac­quired con­di­tion dur­ing an in­pa­tient stay, as doc­u­mented by the Na­tional Pa­tient Safety Foun­da­tion’s 2015 pub­li­ca­tion Free From Harm. And ac­cord­ing to the In­sti­tute of Medicine re­port Pre­vent­ing Med­i­ca­tion Er­rors, med­i­ca­tion er­rors harm an es­ti­mated 1.5 mil­lion in­di­vid­u­als treated in the U.S. each year, re­sult­ing in nearly $3.5 bil­lion in ad­di­tional med­i­cal costs.

En­sur­ing pa­tient safety is a clear lead­er­ship im­per­a­tive. In­deed, lead­ing for safety is health­care ex­ec­u­tives’ moral and eth­i­cal obli­ga­tion. Its mag­ni­tude has be­come in­creas­ingly ev­i­dent to se­nior lead­ers, such that the Amer­i­can Col­lege of Health­care Ex­ec­u­tives’ board of gov­er­nors re­cently re­fined its strate­gic plan to ex­plic­itly iden­tify “safe” care as a de­sired out­come of its ef­forts. When grounded in in­tegrity, this im­per­a­tive is more likely to be ful­filled with an in­ten­tion­al­ity that be­fits its im­por­tance.

As part of my role as ACHE chair­man for 2017-18, I in­tend to demon­strate my com­mit­ment to in­tegrity in lead­er­ship by over­see­ing the or­ga­ni­za­tion’s push for safe and re­li­able care de­liv­ery. For ex­am­ple, I be­lieve the safety of all pa­tients, as well as ev­ery vis­i­tor and team mem­ber, must be a pri­or­ity at ev­ery health­care or­ga­ni­za­tion, and I sug­gest the fol­low­ing four key fac­tors to­ward en­sur­ing an er­ror­free care en­vi­ron­ment:

Com­mit­ment from gov­er­nance. The board must be will­ing to pri­or­i­tize and com­mit the nec­es­sary re­sources—whether peo­ple, pro­cesses or tech­nol­ogy—to ad­dress safety is­sues. It also must be will­ing to de­vote a sig­nif­i­cant por­tion of its agenda to qual­ity and pa­tient safety as a re­flec­tion of the board’s re­spon­si­bil­ity and com­mit­ment.

Ev­i­dence-based safety prac­tices. Why are tools and pro­cesses such as sur­gi­cal check­lists, sur­gi­cal site mark­ing, sponge and in­stru­ment counts and “red rules” (or rules that can’t be bro­ken) nec­es­sary? Be­cause ev­i­dence shows they re­duce harm when per­formed con­sis­tently. Pi­lots never initi- ate take­off with­out go­ing through the pre­flight air­craft check­list. Sim­i­lar safety pro­ce­dures should oc­cur with ev­ery pa­tient, ev­ery time.

Cul­ture of high re­li­a­bil­ity. Hav­ing a cul­ture in which safety is pri­or­i­tized as a core value is crit­i­cal to de­vel­op­ing a high-re­li­a­bil­ity or­ga­ni­za­tion. Health­care lead­ers with high in­tegrity lead with in­ten­tion by hold­ing them­selves and oth­ers ac­count­able for un­safe, un­pro­fes­sional con­duct but don’t pun­ish em­ploy­ees for hu­man mis­takes.

Com­mit­ment from lead­er­ship. As ex­ec­u­tives, we are on stage ev­ery day. Our or­ga­ni­za­tions watch ev­ery­thing we do and say about qual­ity and pa­tient safety. We must de­velop a high-in­tegrity, “no ex­cuses ac­count­abil­ity” mind­set as lead­ers to do the right thing in the name of qual­ity and pa­tient safety.

It is up to lead­er­ship—gov­ern­ing bod­ies and the C-suite—to es­tab­lish a cul­ture of high re­li­a­bil­ity as the foun­da­tion for achiev­ing to­tal sys­tems safety. The ACHE’s core value of in­tegrity is a key in­gre­di­ent in es­tab­lish­ing a safety cul­ture that also is fair and eth­i­cal.

Do we have the for­ti­tude to man­date ev­i­dence-based safety prac­tices in our or­ga­ni­za­tions? Are we will­ing to put pa­tient safety above po­lit­i­cal con­sid­er­a­tion and fi­nan­cial gain? Do we em­power our staff to stop pro­ce­dures when safety prac­tices aren’t per­formed? If the an­swer is yes, then we have the mak­ings of the high-in­tegrity, just cul­ture needed to achieve high re­li­a­bil­ity.

Charles D. Stokes is the 2017–18 chair­man of the Amer­i­can Col­lege of Health­care Ex­ec­u­tives and ex­ec­u­tive vice pres­i­dent and chief op­er­at­ing of­fi­cer at Memo­rial Her­mann Health Sys­tem, Hous­ton.

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