Safety: It's Everyone's Responsibility
Dana Kellis, MD, SVP, CMO, Hospital Division
Safety is one of those overused words that is still poorly understood. Every company has a safety slogan it seems. From “Safety is our #1 priority” to “Safety is no accident,” everyone wants to promote safety.
It’s human nature to assume that we are somehow immune from harm and injury, even though there are many potential ways that a person can be injured, even in a health care environment.
What does it mean to be safe, though? Please join me for a couple of minutes to think about this.
We can all recognize an unsafe environment. A wet floor, a cluttered room, sharp instruments hidden in clothing or trash, excess speed or people acting foolishly in a high-risk situation are just some of the images that come to mind when we think about “unsafe.” But what does “safe” look like?
Safety is different from quality. Most people would agree that a 10% readmission rate or a 1% surgical infection rate for some surgeries represents excellent quality. On the other hand, if 99.99% of commercial airline flights landed safely, that would mean one plane a day would fall from the sky, and few of us would be willing to fly. If 99.99% of the components on a space shuttle worked appropriately, every space shuttle flight would crash because of hundreds of malfunctioning parts, and there would be no space shuttle program. Safety, unlike quality, is not a rate.
Safety is the absence of preventable injury and harm.
I suggest we define safety, then, as an absolute commitment to find preventable causes of injury and remove them from our environment. In a safe environment, we simply would not tolerate occasional preventable failures. For instance, we know that a properly performed time-out makes it virtually impossible to have a wrong-site surgery.
Another example is our medication administration process. BayCare has invested a lot of resources in this process to ensure patients not only get the right medications, but are also protected from receiving wrong medications, or wrong doses of medications.
There is good evidence that trying to eliminate errors through fear and intimidation almost always fails. Punishing people who make mistakes often leads to people hiding their errors, which only makes matters worse. Of course, when someone deliberately or recklessly creates an error, or if someone doesn’t possess the competence to perform a task correctly, appropriate action must be taken.
On the other hand, many errors are more indicative of systemic or cultural problems, and punishing one person won’t fix the issue. For example, if it is common for procedural teams to perform an incomplete time-out, then we need a systemic solution, one that changes the culture that allows this to happen.
We all, as a system of physicians, nurses, staff and administrators, are justifiably proud of the progress we’ve made to improve the quality of care we provide our patients. We are certainly not where we want to be, but we have come a long way thanks to the efforts and commitment of many individuals and groups across the system, and we will continue to improve.
We must also refocus our attention on safety as well – on eliminating risks to patients and employees and physicians. This will be a tremendous undertaking and will require the commitment of every person in the hospital. There is simply no other alternative, though. None of us wants to have to tell a family member, a patient or a team member that they were injured because of a preventable error. Please join with us during the coming weeks and months to achieve in safety what we’ve achieved in quality – a system of hospitals known for excellent and safe care.