The Pennsylvania Patient Authority has enlisted a liaison to help improve patient safety at hospitals throughout the state, beginning in the northeast region and expanding statewide next year. The agency, established in 2002, works to reduce medical errors at hospitals and outpatient centers, requiring that all errors be reported. Since its inception, the agency has received nearly one million such reports.

When you saw the tape of the New York City woman dying on the floor of the emergency room this summer, what was your reaction?

For most of us, it was "How could they just leave her there?" or something like it. If you work in healthcare, you probably think that no hospital worker could ever leave a woman lying on the floor writhing in pain. But the sad truth is that many hospitals have employees who would do just that. They've long "checked out" of the duties they've been assigned. Reporting to work is little more to them than collecting a paycheck, and they're killing your efforts to provide quality, safe, and cost efficient care.

It only takes one apathetic employee to derail a hospital leader's efforts to improve his or her organization. A disengaged employee might fail to wash his hands, forget to verify a dosage of medication, or close up a patient without checking for a stray sponge or instrument left inside. People-and the decisions they make on a daily basis-are the most important part of the care improvement process.

That's why it's no surprise that engaged employees lead to better patient care. Just ask Bev Cunningham, associate vice president for clinical performance at Medical City Dallas Hospital. Several years ago, the 660-bed hospital started an effort to make sure it had the highest-quality, most engaged work force in the area, and has since reaped the benefits-not only in retention rates, but also in patient outcomes.

"As we've watched our employee engagement scores rise, one of the things is that our core measure scores-you can put [them] up against our engagement scores and the trend would be equal," she says.

Medical City employees are proud to be a part of the hospital community, Cunningham says, and therefore, they want the hospital to succeed. This pride has helped the hospital adopt a just culture, which encourages employees to not only report adverse events, but learn from them.

"If someone does something wrong, you have to take care of it," says Cunningham. "But you want to encourage people to report it. If they want Medical City to succeed, they will report those things."

Apathetic employees aren't to blame for every error that occurs inside a hospital, she says, but you can bet money that they don't go out of their way to report near misses.

"Reporting close calls is so important," Cunningham says. "We can learn from them so that nobody ever gets beyond a close call."

Think back to the video of the woman dying at the New York City hospital. Was she the first to ever writhe in pain on that hospital's waiting room floor? We can hope, but I would bet that there have been other instances there when needy patients have been ignored. If those other instances had been reported as a near miss, maybe this woman's death could have been prevented.

Talking about engaged employees and actually getting there are two different things, Cunningham says. But there's one thing she's certain of: "It comes from the top down."

She credits CEO Britt Berrett for Medical City's culture change. By taking just four steps, Berrett and the hospital's leadership team have made Medical City a place where Texas healthcare professionals want to work.

These are:

1. Hire well. "We want to hire the right employee for the job," Cunningham says. "We focus on interviews and really make sure we have the right person in each position."
2. Everyone's accountable. Providing excellent care is everyone's responsibility, Cunningham says, including the chief executive. "The buck stops with him. It stops with me, and my managers and supervisors," she says.
3. Talk to your employees. From 9 to 10 a.m. each day, Cunningham says there are no meetings scheduled at Medical City. That's because hospital leaders-including Berrett himself-are out on the floor, learning how hospital processes work. Executives also host forums quarterly, allowing employees to bring forward concerns. "We're not just talking to them by e-mail, but face-to-face," she says.
4. Celebrate accomplishments. Medical City's efforts have won it several awards in recent years, Cunningham says, and each one, no matter big or small, is celebrated. "We let people know when we do well," she says. "We let them know so they are proud to work here. When you put that pride into them it just affirms that they're doing good work."

For Medical City, keeping the quality of care high is all about keeping its staff happy-and with the challenging reimbursement climate, that's more important than ever.

"Patient safety is top of mind," Cunningham says. "We're being financially penalized for certain things and asked to do more quality reporting. That means that each of us that are leaders in hospitals-if indeed it's true that a happy employee makes a safe patient-then we've got to pay attention to that."

Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.

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