Workforce Safety Panel: The Role of the Health Care CEO in Achieving Zero Harm

Added on Feb 21, 2019

By Andrea Fitzgerald, Staff Writer

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Progressing toward High Reliability requires hospitals and health care systems to shift from a reactive to a proactive approach to preventing harm, according to a panel of Press Ganey experts[1] who shared their thoughts during a recent roundtable discussion.

Adopting a proactive approach requires understanding and acting upon the interdependencies of workforce safety, patient safety, and organizational performance. To advance this cultural transformation, commitment to the goal of Zero Harm must come from the top and permeate every level of the organization. As observed in last month’s post from the roundtable discussion, widespread changes in systems, structures, behaviors, and outcomes that support the delivery of consistently excellent care can only take place with genuine executive sponsorship. This month we look more closely at the CEO’s role in an organization’s High Reliability journey.

Q: What is the role of the health care CEO in achieving Zero Harm?

Don Goble: The CEO’s primary responsibility is to set expectations for organizational leadership on how to observe, report, and respond to both safe and unsafe behaviors of the workforce—whether the latter leads to serious safety events or not. We’ve already spoken about mindfulness being a crucial component of High Reliability, and how leaders who look for and address problems or unsafe conditions before they become major hazards advance the organization toward Zero Harm. The same goes for unsafe attitudes, which must be aggressively rooted out of an organization’s culture. An example that I heard during a client visit is considering it advantageous to have injured employees in light-duty roles to carry out administrative tasks. This attitude is not only erroneous; it is in direct conflict with a safety culture. All injuries, from the most serious to the most minor, are detrimental to organizational performance because they displace workers from where they are most capable of advancing the organization’s performance goals.

Donna Cheek: In addition to mindfulness, rigor is a pillar of any High Reliability Organization (HRO). Health care CEOs must ensure that their organization’s serious safety event review process, as well as their action planning and execution, are consistent and reliable. The nuclear power industry is an ideal model to emulate: It is relentless in its training, oversight, review process, action planning, and auditing. Health care is still working on closing the gap between action planning and continuous improvement, and I think the key will be more rigorous follow-up. It is not enough for organizational leadership to create and implement targeted interventions and solutions. They must verify that those interventions and solutions are in place and are being carried out by all members of the workforce.

Rob Douglass: The CEO must play an active and visible role in achieving Zero Harm not only to ensure this rigor in planning and execution, but also to advance the intrinsic mission of patient-centered health care. Eliminating preventable harm for patients and caregivers is not an initiative or a task to delegate—it is a business imperative. As such, observational audits are a necessity. Self-reported chart reviews are an excellent tool for sustaining a safety culture, but nothing compares to putting eyes on your workforce. Rounding and daily safety huddles are other invaluable opportunities for observing behaviors and any deviations that may not have made it into a report.

Julie Samuelson: By taking such an active and visible role on the front line, the CEO will exemplify safety as a core value that cannot be compromised. There is a temptation to simplify incidents of harm, such as musculoskeletal injuries when handling bariatric patients or assaults when interacting with a volatile patient population, and then implement quick fixes. However, if an organization wants to achieve Zero Harm, leaders must uphold that there is no excuse for assaults, injuries, or harm—no matter the floor or patient population—and thoroughly investigate every serious safety event and near miss. Implementing a flavor-of-the-month initiative or sending out another safety communication won’t change an organization’s systems or employee behaviors. What will change them is advancing a cultural transformation that makes safety the job of every member of the workforce, from the CEO to front-line staff.

This is Part IV 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 III honed in on information that executives need in order to advance workplace safety and the pursuit of a fair and just culture. 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 Strategic Consulting division 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 Strategic Consulting, contributed.