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Quality Update - Wanted: True Safety Leaders

Summer 2010

Wanted: True Safety Leaders

By: Richard "Chip" Davis
Date: July 23, 2010

The Center for Innovation's executive director explains how hospital leaders need to model the behavior they want their frontline staff to adopt for patient safety.


Chip Davis

Richard Gangemi, the vice president for academic and medical affairs at Rochester General Medical System, tells a story that speaks to the need for true leadership in patient safety.

In July 2009, fresh off a three-day visit to The Johns Hopkins Hospital to learn about our safety programs, Gangemi was ready to take action. So, at the end of infection control rounds, he inquired, “How are we going to harm the next patient on this unit?”

This is something that we at Hopkins regularly ask our safety teams, and it’s proven to be a powerful tool for identifying hazards. But at Rochester General, it was a new question, and caregivers looked at Gangemi as if he’d insulted them.

After a minute of awkward silence, a nurse finally spoke up, sharing her concerns about the unit’s rate of Clostridium difficile infections—the highest in the hospital at the time. Other staff soon joined in, and within minutes the group had come up with a host of ideas for reducing transmission, such as replacing cloth curtains in semiprivate rooms with more easily washable plastic ones.

A few months later, the C. difficile rate had dropped to zero, and it’s been there or very low ever since. The unit’s changes became a model for hospital-wide protocols.

In this issue of Quality Update, we highlight the patient safety program that has started taking shape at Rochester General since Gangemi and colleagues visited Hopkins. It’s a story about a whole organization that is starting to embrace a culture of safety. But none of it would have happened without champions at the top.

Leaders can’t just delegate the work of safety. They have to model the behavior they want to see and get out onto the floors. Many health care organizations are still learning how to be transparent and how to encourage caregivers to raise concerns to one another, regardless of hierarchy. When leaders ask frontline staff to identify problems and talk about them directly, it sends the clear message that the organization is serious about embracing these new behaviors.

Gangemi’s question during rounds is but one example of what leaders can do to create safety-supportive cultures. They might alter organizational structures, introduce new processes or provide resources that help teams to meet their goals. There’s no set recipe. 

But what’s almost always required is this realization: Leaders can’t expect change to happen in patient safety unless they make changes within themselves.  

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