Safety Is In the Eye of the Beholder

Jay Moore, for HealthLeaders Media, November 20, 2008

Everyone thinks patient safety is important. Everyone. No, I haven't spoken with every healthcare professional in the United States, but I'm going to go ahead and make that leap. I've never interviewed a hospital executive who said, "You know, we hope our patients are fairly safe when they come here, but what's really important to our organization is supply chain efficiency." I've never heard a physician remark, "You know, I think all this drama over MRSA will eventually just blow over."

Senior leaders, middle managers, doctors, nurses, technicians, frontline staff, housekeepers—they'll all tell you patient safety is critical. Organizations implement advanced technology and send staffers to classes and devise complex systems and craft grand mission statements all in the name of making patients safer.

And yet...

Well, you know the rest. Crippling infections, patient falls, wrong-site surgeries—it's a familiar list to all of you. Even as healthcare professes its dedication to patient safety, a lot of "preventable" occurrences keep right on occurring. Sure, plenty of organizations have made admirable strides in protecting patients. And exhausted caregivers inevitably make mistakes. Technology breaks down. Money is tight.

I know all that. But what is really at the root of the industry's patient safety failings?

There's no easy answer to that one, of course, but I've seen some interesting research lately that points to a problem of perception. A report from Press Ganey Associates shows a major disconnect in how administrators, managers, caregivers, and frontline staff perceive their organization's safety culture. Based on nearly 40,000 responses nationwide, the study found that senior leaders have a much higher regard for their organization's safety culture than many frontline staffers. And administrators tend to view their culture as less punitive than do caregivers, who often fear punishment if errors are reported, the study says.

"No kidding," I can almost hear the physicians and nurses among you muttering. But I wonder if the average hospital executive genuinely understands the extent of the disconnect that can build between the C-suite and the trenches when it comes to patient safety? As the report notes, such differences can stem from a variety of sources—different groups of people are privy to different information, communication breaks down, basic human nature prompts varying responses to the same set of circumstances.

But whatever the origins of the disconnect, the point is that even the most thorough, earnest, technologically supported safety programs can be undermined and solutions delayed if key groups are not aligned.

Perhaps even more significant to me is the gap in perceptions of blame. It doesn't matter what processes you implement or which technologies you utilize—if technicians are afraid mistakes will be held against them or nurses believe reporting errors will be considered "tattling" rather than a collaborative attempt to address an organizational challenge, the system starts breaking down. Senior leaders often refer to their organization as having a "blame-free culture." That's how your executive team feels, sure. But if you asked your nursing staff, would they agree?

It doesn't have to be this way. Oh, people from different backgrounds who are educated in different disciplines and are charged with performing different tasks will inevitably have varying perceptions to some degree. But when it comes to basic communication and information access, there's no excuse for failing to close the gap. How can an organization fix a problem if the components of that organization don't collectively recognize the problem in the first place?

Jay Moore is managing editor for HealthLeaders magazine. He can be reached at
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