Culture Construction

When the leaders of Chesterfield, Mo.-based Sisters of Mercy Health System decided to make patient safety a key fixture of their system culture, they knew success depended on grounding the move in the cultural identity already in place. Leaders are aiming to make safety a priority throughout the organization by encouraging reporting of errors and near misses, strengthening their root-cause analysis process and creating a communication system that allows hospitals to share and learn from each other’s experiences. The system operates 18 acute-care hospitals across Missouri, Arkansas, Texas, Kansas and Oklahoma. To be effectively implemented in spite of the distance between facilities, the waves of cultural change had to reach all employees without losing momentum. Several factors have helped Sisters of Mercy’s safety initiative sink in.

1. Draw parallels to existing cultural mainstays

Adding elements to existing programs with which employees already identify can make a big difference in the way a new direction is accepted. Since 1998, the “Mercy Service” philosophy has been Sisters of Mercy’s foundational commitment to providing quality personal and clinical service to patients. As vice president of medical services at Sisters of Mercy, Jolene Goedken oversees physician and nursing leadership and clinical quality. She calls Mercy Service “the lifeblood of the system.” Regardless of the subject matter or aim—be it establishing a computerized physician order entry system, barcoding medications or working to boost patient-satisfaction scores—all of the initiatives Sisters of Mercy pursues are viewed through the lens of how they can improve service for patients as well as staff.

Leaders have begun to weave the thread of safety into this established cultural marker. Because the patient safety initiative is tied to the service emphasis, Ron Ashworth, president and CEO of Sisters of Mercy, says people in the organization take it very seriously. “They know it’s not just a program of the month,” says Ashworth. “It is who we are.”

2. Motivate and follow through

One important aim of a hospital’s culture is to make employees feel good about their work. Focusing on service leads to improved care for patients and a simpler work environment, which helps motivate workers and physicians, Goedken says.

Like other organizations seeking a culture of safety, Sisters of Mercy is working to create a blame-free environment. “You’re on the road to success if workers believe the presumption is that there’s a process issue to be dealt with as opposed to a personnel issue,” says Bernard Duco, senior vice president and general counsel for the system. By stressing this nonpunitive structure, Sisters of Mercy hopes staff members will be more inclined to report errors so the process can be improved.

Another major component for getting employee buy-in is showing them that the system keeps its end of the bargain and follows up on staff reports, Duco says. “Employees will be watching very carefully. Should we take an action that is perceived to be punitive, we’ll have taken five steps back in the cultural issue,” says Duco. “They’ll say it’s business as usual and that we really aren’t changing.”

3. Communicate consistently across the organization

Introducing a new initiative across a large network of hospitals isn’t a new problem for Sisters of Mercy, says John Sullivan, executive vice president and chief operating officer. “Because we’re so spread out, we deal with the same thing whether it’s personal service or revenue management or any other quality initiative that we undertake,” he says.

The system has had success keeping initiatives alive by creating steering committees that include system leadership and regional representatives to oversee the progress of implementation. A mirror oversight committee is formed in each region, so the senior leadership is responsible at the local level, as well, Sullivan says.

Sisters of Mercy uses communication methods with which employees have become comfortable. For example, Sullivan says employees are accustomed to “meeting in a box”—the organization’s term for the 20-minute educational videos that the system sends out to all hospitals when it needs to get information directly to employees.

The system also is developing a safety center to coordinate the initiative across the organization so that it becomes more of a partnership than a mandate, says Goedken. Having a central point of contact allows best practices to be more easily shared with the group. “It’s important to provide the forums and structure to allow for cross-communication and also to pool resources from other organizations,” says Goedken.

To Duco, consistency is key. Repetition will show employees that true change is afoot, and that is how the culture will begin to take hold, he says.

4. Start at the top

Mercy started its emphasis on safety by talking to senior leadership. System leaders must communicate to regional executives that this is a systemwide focus, says Goedken. The kick-off conference for the initiative drew around 200 executive and physician leaders from across the regions, and the system followed up by building its two-day fall leadership development program around safety, as well. Next, information was filtered down to the director level with one-day regional conferences.

The involvement of leadership is essential to getting the message across. “Everyone in healthcare is overloaded, so every time you roll out a new initiative, they think maybe if they lay low for a while it’ll go away,” Duco says. “Employees and management have to see that leadership is committing time and resources.”

Organizational leaders establish the cultural tone. In Sisters of Mercy’s case, it’s up to the leaders to set an example that says safety is a priority. “The leadership has to preach it,” says Ashworth. “Then you act on the reporting and create strong processes, and that’s where the accountability will come from.”

—Kara Olsen