Workforce Safety Panel: Engaging Executive Leaders in Systemwide Safety Efforts

Added on Jan 22, 2019

By Andrea Fitzgerald, Staff Writer

teamwork (1)Hospitals and health care systems on a journey to becoming High Reliability Organizations (HROs) need leadership to champion safety efforts from the executive level to the front line, according to a panel of Press Ganey experts[1] who participated in a recent roundtable discussion on workforce safety.

In addition to having a clear line of sight to their organization’s safety goals, as addressed in the first two posts of this blog series, leaders must maintain a preoccupation with failure. Those who consistently search for latent hazards and weaknesses in their health systems, visibly emulate and promote safety behaviors, and recognize Serious Safety Events as learning opportunities rich in data will help advance their organizations toward the goal of Zero Harm, according to the strategic framework laid out in Zero Harm: How to Achieve Patient and Workforce Safety in Healthcare.

In last month’s post, the panel focused on the steps organizational leadership can take to foster a culture that empowers every caregiver with the motivation and psychological safety to speak up for safety. In this post, they hone in on information that executives need in order to advance workplace safety and the pursuit of a fair and just culture.

Q: What questions would you pose to health care executives, including the CEO, CNO and CMO, about their organization’s efforts to keep their workforce safe?

Rob Douglass: First, I would ask, “Do you know the name of the last person that was harmed in your organization and what the injury was?” Second, “Do you believe the injury could have been prevented?” And finally, “Do you believe that all workforce injuries are as preventable as patient injuries, and are you working to achieve Zero Harm for both?” I think those questions would give a sense of the workforce safety culture and values of the organization as a whole.

Julie Samuelson: In addition to Rob’s questions, I would ask those three executives as well as many other senior leaders how they are communicating that the safety of patients and employees is a priority at their organization. Specifically, what in their messaging and actions demonstrates on a daily basis that these priorities are at the core of every behavior, process and initiative across the organization? This goes back to Rob’s comment about culture. Supporting a fair and just culture requires that incidents of injury or harm be used as learning opportunities to shift the organization from responding to anticipating Serious Safety Events. So I would also ask leaders how we can learn to be proactive in preventing injuries, assaults and other types of occurrences to ultimately create safer environments.

Donna Cheek: Additionally, I would ask those executives what their greatest workforce injuries are and when they last observed the front-line caregivers performing the high-risk tasks that lead to those injuries. Then I would ask them to consider how to help those caregivers deliver safe care throughout those tasks and the care experience.

Q: How does the pursuit of a fair and just culture through education and communication influence accountability?

Julie Samuelson: I think upholding a fair and just culture—which should foster accountability, not preclude it—requires assessing what is system-related versus what is individual-related, much like we do in our common cause analysis work. If a system-related issue is identified in an analysis of Serious Safety Events, then it is my responsibility as a leader to solve it, because I am accountable for providing my team with the guidance and resources that allow them to provide a safe, high-quality experience of care. However, if it is an individual-related issue, such as a lapse in attention to detail or policy, then it is my responsibility to investigate, before taking any disciplinary action, whether the individual’s actions were intended or unintended and whether the individual is being provided the proper education, resources and support. Accountability is sometimes thought of as punitive, but really, accountability is about helping people learn and deliver the best care possible.

Rob Douglass: That’s an important point about accountability, and we as health care leaders could apply a similar rigor in understanding the causes of noncompliance. When faced with such an event, leaders should examine their systems and processes. Are they cumbersome and adding burdens on the workforce rather than solving them, prompting some individuals to find an easier way? Does the workforce understand the risks of such noncompliance? Is there a prevailing attitude to do the right thing, so much so that peers will stop others from executing unsafe behaviors? It’s much more productive to view and act on noncompliance as a possible leadership issue rather than only as “an individual making bad choices” issue. For example, if a Serious Safety Event points to a lack of championing safety and reliability, then leaders can decide how best to embed these behaviors into their culture. It might mean supporting caregivers who take the time to incorporate safe patient handling interventions and other policies, even if it affects their productivity goals at the beginning. If viewed this way, noncompliance becomes a springboard for action and continuous improvement throughout the organization, rather than a punitive endpoint.

This is Part III in a seven-part series on making the health care workplace a safe and highly reliable environment for patients and caregivers. Part I identified deficiencies in data, education and investments in workforce safety as top obstacles for health care organizations to overcome on their journey to Zero Harm. Part II provided insights into the possible detractions from reporting or speaking up about unsafe practices resulting in errors and harm. Part IV takes a closer look at the CEO’s role in an organization’s High Reliability journey. Part V discusses ways in which measurement and reporting can inform and inspire every member of the workforce to reduce harm. Part VI explores the ways leaders can support and empower occupational nursing staff to sustain the organization’s safety culture. Part VII will conclude the series with reflections and advice from the panelists to those in health care considering the commitment to a highly reliable workforce.


[1] Panelists from Press Ganey’s Transformational Advisory Services include Donna Cheek, a safety expert with more than four decades of health care experience in multiple executive and nurse executive roles; Rob Douglass, a safety expert and former commanding officer with 30 years of experience in the nuclear naval and commercial energy industries; Don Goble, a safety expert with more than 35 years of experience in naval and commercial nuclear power; and Julie Samuelson, RN, a patient experience expert with more than 40 years of experience in health care across a range of settings. Christy Dempsey, chief nursing officer and president of Clinical Excellence Solutions, moderated the discussion, and Craig Clapper, partner of Transformational Advisory Services, contributed.