Maintaining A Culture of Safety During Transformation

Craig Deao, Vikki Choate

In Brief

7-Minute Read

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Healthcare leaders are juggling an ever-growing list of priorities, all deemed most important: managing costs, growing revenue, streamlining operations, recruiting qualified talent and many others. However, as the Hippocratic oath declares, a physician’s first duty is to do no harm; in the business of keeping people healthy, there can be no priority more important than safety.

Though maintaining a high level of safety is a continuous challenge, it is even harder to maintain during times of transformation. Mergers, acquisitions, consolidations and partnerships bring structural and operational adjustments. New leadership disrupts the chain of command, making it unclear who is accountable for what. In the midst of such change, much can fall through the cracks or end up on the back burner. But healthcare leaders cannot afford to sacrifice safety in lieu of other obligations. To preserve and maintain a culture of safety during transformation, healthcare organizations must have in place the right people, processes and technology.

The People

In 1987, the aluminum company Alcoa began an incredible journey. Paul O’Neill, chief executive officer, decided that instead of measuring success in terms of revenue, expenses, earnings and other financial metrics, the company would measure success in terms of employee safety. For more than a decade, Alcoa’s dedication to safety decreased the company’s worker injury rate to one-twentieth the national average, making the company one of the nation’s safest places to work. In that same time, Alcoa experienced significant financial growth; annual net income quintupled, and its market capitalization increased to $27 billion. Alcoa achieved an unheard-of return on investment (ROI) by transforming the company’s culture.

Alcoa’s story has significant implications for the healthcare industry: A recent study concluded that 1 in 10 patients experience a safety event while receiving medical care, half of which are preventable. Additionally, at least 12% of preventable errors result in permanent disability or death. Healthcare leaders have a moral responsibility to establish robust cultures of safety within their organizations, not only for patients but also for employees. Much emphasis has been placed on developing leaders who can create well-functioning teams and increase productivity, but healthcare organizations also need leaders who champion safety — those who can uphold accountability and display an unwavering commitment to zero harm. Healthcare organizations can empower their employees to maintain a high level of safety, even in a constantly changing environment, by:

  • Deferring to expertise. Front-line employees have extensive knowledge and skills that make them the experts of their realm. These employees must be able to react quickly in any situation; save valuable time by decentralizing decision making and enabling your teams to solve problems on their own.
  • Developing a preoccupation with failure. Highly reliable organizations have a healthy obsession with what could go wrong and seek to fix problems before they happen. Establish daily executive-led leadership safety huddles where all department heads discuss the safety events of the previous 24 hours, as well as review what is happening in the next 24 hours that could pose a safety risk.
  • Staying connected. Regularly round with employees as the organization moves through change. Explain the reasons for the changes and what they mean, both for the organization as a whole as well as individuals. Address any safety concerns staff members report, and intentionally communicate the organization’s complete commitment to zero harm regardless of the changes.
  • Preserving a transparent and supportive culture. It is critical that employees are enabled to report safety events without fear of retribution. Create an environment that focuses on finding the root causes of safety events and developing solutions — not on placing blame.

The Processes

Alcoa’s success came not only from transforming the organization’s culture but also from scrutinizing how the organization operated. The company uncovered a number of processes that jeopardized workers’ safety and were inefficient for working with aluminum. It was the change in these processes that enabled the company’s high financial growth.

Likewise, healthcare organizations must take a critical look at their operations and processes to identify inefficiencies that could lead to preventable safety events. To do so means the organization will need to look at all processes, not just the ones that directly touch the patient.

For example, many patient safety issues can stem from poor information technology practices, improper disposal of hazardous materials and incomplete patient records. In the thick of transformation, many factors can put patients in danger. Healthcare leaders can reduce these risks by:

  • Being reluctant to simplify. Processes shouldn’t be overly complicated, but leaders must be resolute in their commitment not to take shortcuts, even when things are busy. Sophisticated processes not only produce predictable and repeatable outcomes but also make it harder for people to do the wrong thing.
  • Asking for input from employees. Based on where they sit along the process’s trajectory, employees offer a different perspective that will be useful in identifying existing problems in the current process as well as potential problems in proposed changes.
  • Making transparency nonnegotiable. It is everyone’s responsibility to properly document or record important patient details and other health information that informs the actions of nurses, anesthesiologists and other physicians down the road.
  • Committing to resilience. Refuse to be paralyzed by harm events. Proactively audit processes for efficiency and effectiveness. Investigate what caused the breakdown in process and how it can be improved. Make the appropriate changes and then communicate those changes across the organization.

The Technology

Technology is a powerful tool for patient safety. It can be used to reduce any number of errors, from the minor to the catastrophic, and uncover the root causes of safety issues to resolve them permanently.

However, technology’s most significant benefit to consumers is in enabling us to do meaningful work. By offloading nonclinical tasks, healthcare professionals can spend more time caring for patients. That extra time with patients could mean the difference between a satisfactory patient experience and an exceptional one — not to mention life and death.

Healthcare leaders can breathe life into their growth strategies by:

  • Working in real time. Explore machine-learning tools that identify and measure safety risks as they happen. This allows caregivers to be both reactive and proactive in protecting their patients, either by intervening as quickly as possible during a safety event or by giving the provider enough time to step in before an error happens.
  • Utilizing historical data and analytics. By understanding what has caused problems in the past, healthcare organizations can prevent them in the future.
  • Collaborating with your experts. Work with the organization’s information technology experts to audit current capabilities. Identify areas where digital and other technologies can aid in mitigating safety risks.

When healthcare organizations focus on safety, it provides the foundation for high reliability and clinical, operational and financial success. With the right people, processes and technology in place, healthcare organizations can maintain a culture of safety through any transformation, maximizing outcomes for patients while minimizing life threatening risk.


To maintain a culture of safety during transformation, healthcare leaders must:
  • Think differently.
    Redefine success in terms of patient safety and set the bar at zero harm.
  • Plan differently.
    Collaborate with employees to create processes that both mitigate and eliminate safety risks.
  • Act differently.
    Invest in technology that makes it easier to maintain a culture of safety by providing both real-time and historical data.

Written by Craig Deao, MHA and Vikki Choate, MSN, RN, NEA-BC, CCM, CPHQ

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