CMOs, Non-Punitive Workplace Culture is Essential for Patient Safety

When patient safety concerns arise in a non-punitive workplace, the emphasis is on improving processes rather than blaming individuals.

Establishing a non-punitive workplace culture is a cornerstone of patient safety, a trio of top clinical leaders say.

Patient safety is a top priority for CMOs and other clinical leaders. These leaders must foster a non-punitive workplace culture to encourage frontline staff members to report patient safety concerns and events.

"If there is a recognition that there is a potential patient safety event, whether it is a medication event, equipment event, or staffing issue, those concerns must be brought to leadership," says Jennifer Khelil, DO, MBA, executive vice president and chief clinical officer of Virtua Health. "Staff members must feel comfortable bringing these concerns to leadership. If the culture is punitive, people are not going to speak up."

Having a non-punitive workplace is part of a culture of patient safety, where staff feel comfortable speaking up without fear of backlash, according to Kevin Post, DO, CMO of Avera Health.

"They can speak up for the safety of the patients and the safety of their coworkers without fearing retaliation coming back against them," Post says. "That starts with leadership and putting systems in place where we encourage our staff members to speak their mind; and when they do, we reward them and recognize them."

With a non-punitive culture, staff members are more likely to report when they are involved in a medical error, according to Sylvain "Syl" Trepanier, DNP, RN, chief nursing officer at Providence.

"They won't shy away from raising their hand and saying they made an error," Trepanier says. "You learn together, and you do not blame the individual. You focus on the processes."

Jennifer Khelil, DO, MBA, is executive vice president and chief clinical officer of Virtua Health. Photo courtesy of Virtua Health.

How to promote a non-punitive workplace

To establish a non-punitive workplace, healthcare leaders need to be visible and to interact with care teams, Khelil explains.

"They need to be on the floors with the care teams," Khelil says. "They need to thank teams and staff members who bring concerns forward."

Healthcare leaders should also follow up when patient safety concerns are reported, according to Khelil.

"When a staff member brings a concern to you that could have turned into a patient safety event, you need to close the loop and circle back to that individual," Khelil says. "You need to let that individual know that because they spoke up, a change was put into place so that the issue does not arise again."

In a non-punitive workplace, staff members should be recognized and rewarded when they report patient safety concerns.

Avera Health has a Good Catch Award, which is given to staff members when incidents occur that could have caused injury or harm to a patient, but it was caught before it reached the patient. The health system has a process where frontline caregivers can report when a good catch occurs, and learnings can be disseminated throughout the entire health system.

"So, if an error nearly occurred in one area of our health system, we have a communication channel in place to share that learning in a confidential way," Post says. "We also lift up the employee who had the courage to speak up for the greater good of the patient and the organization."

Healthcare leaders in a non-punitive workplace are aware of the working conditions and care processes at the frontlines, according to Trepanier.

"You can't be a subject matter expert at everything, but you need to know what resources are available and what the work is about," Trepanier says. "You need to have a lot of curiosity and ask a lot of questions. You should not resort to blaming people in the first instance and focus on the processes instead."