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Getting to zero

Patient safety, leadership, and you

Section Editor(s): Raso, Rosanne MS, RN, NEA-BC, FAAN

doi: 10.1097/01.NUMA.0000602832.72807.15
Department: Editorial
Free

Editor-in-Chief, Vice President and CNO, NewYork-Presbyterian/Weill Cornell, New York, N.Y.

Brave leaders and frontline caregivers are needed when facing headwinds to reliability and high performance standards.

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Whenever you read about zero patient harm, whether it's safety culture, work environment, high reliability, “high-quality care,” or even continuous learning systems, what's the underlying bedrock of all of them? You guessed right, it's leadership. Real, down-to-earth, unrelenting leaders, at every level and from every discipline. In one definition, leadership is the “action of leading employees to achieve goals.” Is one of your goals zero patient harm?

Yes, there are other factors and, of course, there are other goals. Can you, yourself, influence enough to make a difference? Yes, you can. And must. There's a litany of nursing-sensitive quality and patient safety outcomes that are way too important to take a backseat in our everyday activities, and achieving those outcomes is completely intertwined with our other goals. Efficiency, patient experience, staff engagement, healthy workplace, and even financial stability are all intersected with quality and safety. It doesn't take long to draw the lines that connect them all.

Patients should be able to expect the same level of safety when they enter a hospital or healthcare setting as they do when they board a plane. The World Health Organization stated in 2018 that patient safety is a serious global public health concern. This is bigger than you and me—it's universal.

We fought the possibility of zero for a long time with questions such as “Aren't complications inevitable?” and “Is it really possible?” Yes, it is. There are repeated examples of systems implemented on units and within organizations that lead to zero harm. Okay, maybe zero isn't sustained indefinitely, but that doesn't mean it isn't a goal that's valuable and worthy of our attention.

This brings us to high reliability and why it's still so elusive. Whether your circle of control is at the unit level, multiple units, or even at the patient level, what every person does counts. Valid, understandable, transparent, and frequent measurement is critical—we all know that daily and weekly reviews of process and outcome indicators make a difference. Sloppy practice just isn't acceptable.

Local culture matters, too; it isn't all about organizational culture. Communication expectations, focusing on learning and appreciation, and robust performance improvement models, to name a few local cultural elements, are within your control. The Joint Commission issued a sentinel event alert in 2017 solely about the “essential role of leadership in developing a safety culture.” Understanding systems approaches rather than blame is a key tenet, yet too often not followed.

Let's not be piecemeal and disjointed in our approaches. That's when we lose the trust and confidence of our staff members, who usually can lead the way to improvement themselves. We must use positive, relational leadership balanced with firm hands-on accountability—it can be done. The prevention bundles to avoid harm are established, there's no flexibility there, and allowing innovative and creative strategies to execute those bundles never fails to mobilize and engage stakeholders, including patients. There's also an element of courage in approaching patient safety; brave leaders and frontline caregivers are needed when facing headwinds to reliability and high performance standards.

This is our annual Safety Solutions issue, with stories of success that will challenge you to do more and better. I urge you to accept the challenge, learn, be courageous, and lead your followers to zero patient harm. It really isn't an option.

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