Leadership in Action: Prioritizing Safety Starts at the Top
To say hospital executives are constantly managing competing priorities is a bit of an understatement. Overseeing institutions that provide lifesaving care every day while trying to address staffing shortages, support their communities, resolve financial challenges, and keep their staff productive and happy is a daunting prospect. It’s little wonder that embarking on a new patient safety initiative or trying to improve quality rankings isn’t high on many leaders’ list of priorities.
But to perceive quality and safety as somehow distinct from a hospital’s fundamental mission and overall financial health is a mistake.
In the final entry of our interview series on healthcare quality and safety, ECG’s Tim Babineau, MD, and Kim Adelman, PhD, explain why patient safety and the hospital’s bottom line are inextricably linked—and why it’s up to leadership to make quality a top priority.
Is quality and safety a priority for the C-suite?
Tim: It should be. It starts at the top of the organization. Kim and I have done a lot of work in a lot of different organizations, and I would say the number one defining characteristic or distinction between high-performing organizations in the area of quality and safety and low-performing organizations is leadership. If the leaders of the organization, including the governing board, declare out loud and frequently, “this is a priority,” those organizations tend to perform quite well. In organizations where it’s one of 10 priorities, those organizations tend not to perform as well. So it’s imperative that the leaders of the organization say out loud “quality and safety is our number one priority.” Everything else follows from that.
Kim: I absolutely agree. Here’s the interesting thing: the American College of Healthcare Executives does annual surveys on the top issues that hospital leaders are focused on. For the past two years, the top two focus areas have been financial and workforce challenges. And when you look at that list of priorities, patient safety and quality and patient satisfaction are ranked right around number six or seven.
That tells me those leaders are thinking of workforce shortages and financial challenges as separate from patient quality or patient satisfaction. But if you improve your quality and patient safety, you’re going to improve your financial challenges by lowering your costs and increasing revenue or reimbursement, and also address staffing challenges because you’re going to have lower staff turnover and you’re going to improve your ability to recruit high-level clinicians and providers, including specialists. So it shouldn’t be thought of as a separate initiative but as a foundational piece for those top challenges that have been identified through these surveys.
Tim: Kim is spot on. If you asked 20 CEOs and 20 board chairs whether they thought quality and safety was important, none of them would say no, and none of them would say it’s not a priority. But I think we’ve lost sight of the fact that quality and safety is the predicate for everything that comes after—workforce challenges, finances, physician resiliency, burnout, staff satisfaction. Leaders of the organization need to better articulate that without quality and safety being prioritized, all the other stuff—a positive bottom line, workforce recruitment—is harder to do. But as Kim pointed out, when you ask people where quality and safety ranks, it’s falling down around five, six, or seven. It should be clear that it’s number 1. That’s just a given.
You’ve indicated that organizations often feel daunted by the prospect of evaluating and changing their quality and safety programs. If they’re reluctant to get started, what do you tell them?
Tim: I remind governing boards that the only morally and ethically justifiable target is 0 or 100: either it happens 0% of the time or it happens 100% of the time, depending on what you measure. I can’t tell you the number of people who have told us something like, “last year we had we had four retained foreign objects; our goal this year is to only have two.” No—the goal is 0. You’ve got to recalibrate the organization to understand that the goal is zero harm. Or it’s doing something 100% of the time. And anything in between is not ethically or morally justifiable.
Kim: You’re going to be able to grow your revenue by having a better competitive position and public perception in the community. You’re going to be able to maximize your pay-for-performance incentive reimbursement. You’re going to improve your patient throughput and increase your beds for those patients who are truly sick and need that hospitalization versus those who are staying in your hospital because they’ve had something go wrong during their hospital stay. And on the cost reduction side, you’re avoiding penalties. Reducing litigation settlement costs, streamlining operational efficiency, eliminating care variation—all of that will drive your costs down.
