Practice Management

Fostering a Culture of Patient Safety

What steps can you take to avoid medical errors?

Clinicians gather to discuss patient case

Despite initiatives to improve patient safety, medical errors cause at least 250,000 deaths annually and are now the third leading cause of death in the U.S. after heart disease and cancer, respectively. Patient safety expert Peter Pronovost, MD, chief clinical transformation officer at University Hospitals in Cincinnati, OH, and Allen Kachalia, MD, JD, director of the Armstrong Institute for Patient Safety and Quality in Baltimore, MD, offer key elements for fostering a culture of patient safety.

Always Make Patient Safety the No. 1 Priority

Both Kachalia and Pronovost recommend taking cues from the aviation industry. “Safety culture is the most important aspect of care,” Pronovost says. Kachalia comments, “The airline industry has figured out that it must take all the right steps before a plane can fly. It doesn’t matter how late the plane is—they have to do it right. That’s what we’re evolving to in health care.”

Safety Culture Starts at the Top

Strong leadership is essential to consistently support and promote everyday patient safety measures. “The key is creating an environment where everyone’s voice is respected, people feel safe to raise concerns, and there is a belief that leadership or management will do something about those concerns,” Pronovost says. “Too often, those kinds of attributes don’t exist. There is either a fear of retaliation or perception of futility that nobody is going to really do anything about this.”

Focus on Risk, Not Events

One simple and effective patient safety strategy is for practices to form their own safety team. The team should include a variety of staff and meet regularly. “The key question a safety team should ask is: ‘How might our next patient be harmed in this practice, and what can we do about it?’” Pronovost says.

Similarly, Kachalia recommends that practices focus proactively on risk, not events. “Leadership should constantly be talking to staff about what risks they are worried about. Those questions should be routine,” he points out.

Include Patients and Family Members in the Safety Team

A culture of safety is a culture of respect, Pronovost emphasizes. “Nurses, staff members, and caregivers may have greater knowledge of potential safety concerns than physicians who may spend comparatively less time with patients,” he says. “If a parent, spouse, partner, or nurse is worried about something, we have to give heed to that.”


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