Opinion: Maintaining a culture of safety in challenging times

Dr. James Hill Jr. (left) is chief operating officer and a critical care anesthesiologist at University Hospitals Parma Medical Center, and an assistant professor at the Case Western Reserve University School of Medicine. Dr. Peter Pronovost is chief quality and clinical transformation officer at University Hospitals Health System, and a professor at the schools of medicine, nursing and management at Case Western Reserve University.

The COVID-19 pandemic brought pain, stress and change on caregivers throughout healthcare organizations. Clinicians, already overburdened prior to the pandemic, suffered moral injury. Conditions and burnout drove the Great Resignation, creating record turnover. Out of necessity, contract labor was needed to care for waves of patients. The staffing crisis endures.

Despite a recent decline in contract labor use, staffing challenges, patient volumes and inflation have pushed health systems into ominous territory. According to consultancy Kaufman Hall, hospital costs have risen about 20% compared with pre-pandemic levels, while net operating revenue increased 15%. About half of U.S. hospitals ended 2022 with a negative margin.

The industry has also seen a decrease in healthcare quality and patient experience compared with standards before the pandemic, according to the Leapfrog Group. Reporting from the Centers for Disease Control and Prevention also shows significant increases in healthcare-acquired infections. A recent Gallup poll shows Americans’ perception of healthcare quality at a decade low.

Given these challenges, every healthcare leader knows they must change, but many don’t know how to start or lack a framework to build upon. Here are some suggestions:

Be purpose-driven

Patients are accustomed to healthcare organizations making great efforts to provide high-quality care and a superior patient experience. Establishing and maintaining a culture of safety begins with the belief that zero harm is possible, even under challenging circumstances. Evidence-based medicine provides extensive opportunities to improve patient outcomes, but frequently, due to operational issues, the gains are never realized. Although it’s possible to understand why quality shortfalls exist, they should not be accepted as inevitable.

Why should that never be the case? The “why” is the reason people go into healthcare. It’s a reflection of personal values that can cut through the moral injury suffered during the pandemic and reinvigorate passion at the personal level. Refusing to be content with providing mediocre services should be the North Star guiding all healthcare professionals and their organizations.

Be principle-led

Given the stress caregivers face, some have developed feelings of distrust and abandonment, often leading to apathy and anxiety. To build trust, resonant leaders must operate with authenticity, acknowledging these feelings exist. Empathy is foundational to sustaining relationships with frontline caregivers. Emotionally intelligent leaders also use it to reignite passion toward organizational goals and purpose.

It’s also essential to create a culture of shared accountability to continuously improve oneself and the organization. It starts with holding oneself responsible first for a team’s success. More than ever, healthcare leaders are under a microscope. Key leadership principles include humility, compassion and curiosity. High degrees of leadership accessibility bring renewed credibility and form a bond with frontline staff. Respect and appreciation empower everyone within an organization to innovate and solve problems. That empowerment drives a “speak-up culture” and shifts leadership behavior away from “command and control” to “unleash and inspire.”

Be performance-focused

Reigniting caregivers’ “why” is critical to maintaining a culture of safety, but it will lead to frustration if there is no enabling infrastructure making it easy to correctly care for patients. Pandemic-driven financial challenges have made many organizations scale back services. Regardless of the circumstances, however, organizations have an obligation to ensure patient safety. This is especially true with contract labor, because they’re likely to be unfamiliar with nuances in care delivery at different organizations. An effective method to support these caregivers is retaining core employees in an education or oversight role to increase safety and effectiveness. Medicine has become increasingly technical, with a growing need for specialized staff. Patients, however, perceive basic bedside care such as bathing, positioning and ambulation as a reflection of care quality and overall experience.

Unleash the power of the total healthcare team to support frontline caregivers. Remember that every hospital employee is a caregiver. Drive the belief that safety and experience are shared responsibilities, and encourage inter-departmental partnerships to help identify problems and develop valuable, unconventional and innovative solutions. During difficult times, an inspired team will rise to the occasion.