Expert defines culture of safety as an environment where no one fears speaking up for the patient

Expert defines culture of safety as an environment where no one fears speaking up for the patient

Michael Leonard, M.D.
Nationally known patient-safety expert Michael Leonard, M.D., spoke about fostering a culture of safety at Christiana Care's 9th Annual Focus on Excellence Awards.

Hospitals don’t have to hire rocket scientists to create a culture of safety, nationally renowned patient safety expert Michael Leonard, M.D., said during the Focus on Excellence Awards at Christiana Hospital’s John H. Ammon Medical Education Center. Rather, hospitals simply need to embolden every member of their health care teams—from the surgeon to the nurse to the custodian—with the power to speak up if they observe something either wrong or questionable regarding the treatment of a patient under their watch.

“The issue we are looking at is how to create an environment where no one is hesitant to speak up,” said Dr. Leonard, an anesthesiologist and a principal at Pascal Metrics. “At some places, the housekeeper has been the worker who told the surgeon that they were doing a wrong-site surgery.”

Dr. Leonard is one of the foremost experts on patient safety, having trained more than 1,000 patient-safety officers worldwide. He also co-published “The Essential Guide for Patient Safety Officers.”

It’s one thing for hospitals to adopt nationally-recognized policies that encourage patient safety, Dr. Leonard said, but tangible improvement only occurs when the staff members feel responsible to adhere to those policies. When all members of a health care team prioritize patient safety, the hospital is on the road to lower rates of unnecessary infections, wrong-site surgeries and medication errors.

“Culture’s local,” Dr. Leonard said. “Systems evolve broadly but culture evolves at the local level.” Patient safety links inextricably to psychological safety among the health care workers, he observed. No employee should fear that they will be punished or humiliated for speaking up with ideas, questions and concerns.

A disarming way to bring up a concern, Dr. Leonard said, is to declare, “I need some clarification.”

“You want everyone to feel comfortable raising their hands and voicing a concern,” he said.

Another key component is to measure and track patient safety throughout the year. Those charted measurements should be documented and mounted in a public place of the hospital—such as a hallway or boardroom—so that patient safety is more fully permeated into the hospital’s culture.

Dr. Leonard said that the “Focus on Excellence” initiative by Christiana Care reflects the health system’s commitment to patient safety. Christiana Care’s goal is to become one of the top patient-safety health systems in the nation and boast both the lowest cost of care and best outcome of care in the mid-Atlantic Region among health systems.

“You guys are doing a lot of wonderful things,” he said.

Dr. Leonard cited studies published in the Journal of the American Medical Association and The New England Journal of Medicine that demonstrate how effective communication and teamwork results in better patient outcomes.

He listed other steps that embody a culture of safety: Health care staff should rehearse procedures they are about to perform. When mistakes are made, the staff should reconvene to evaluate where the failure occurred, as opposed to who made the error. Those actions also decrease the likelihood of recurrence.

“The challenge that we are facing is to hardwire these basic processes into the way we treat patients every day,” he said. “It is simple thing to do but it also is a hard thing to do. Still, it is an intentional act that we must take to improve patient safety.”