True Patient Safety Begins at the Top

Physician Executive, Sept, 2001 by James P. White, Susan D. Ketring

* Patient safety is a priority for each facility's quality program, working in coordination with risk management and existing performance improvement structures and processes.

The starting point

Establishing and maintaining a culture of safety is a long-term proposition. We are just beginning. Senior leaders are meeting face-to-face with clinical staff on all units to talk about patient safety and their involvement. We need staff to talk about safety, to feel comfortable discussing errors or hazards with colleagues and to report problems without fear of blame.

As we move ahead, our organizations must learn more about errors and potential hazards, improve our reporting systems and gain knowledge about how to create a safer environment.

The ultimate goal is, of course, correction and prevention, which will require more effective analysis and improvement processes.

All of us need to:

* Understand more about human errors and latent failures in our systems.

* Avoid blaming someone when mistakes occur.

* Support our physicians, nurses and pharmacists.

* Lead our hospitals' efforts to strengthen our defenses.

We must help our medical staffs understand their responsibility to improve communication with other members of the care team, ensure that their orders are written or stated clearly and that their intentions are well understood. Administrative and medical staff physician leaders play a critical role in improving patient safety.

James P. White, MD, is chief medical officer and managing director for medical affairs at INTEGRIS Health, a health system headquartered in Oklahoma City. Certified by the American Board of Internal Medicine, White practiced full-time from 1981 until January 2001, when he became the CMO. He still maintains a part-time practice. Leading the patient safety effort for INTEGRIS is currently his first priority.

Susan D. Ketring, MSM, is vice president for quality and medical staff services at INTEGRIS Health. Ketring is a biostatistician and helps to lead the patient safety effort while overseeing the organization's quality efforts, medical staff support functions and accreditation activities.

References

(1.) Kohn, L.T., Corrigan, J.M., Donaldson, MS. (Ed.) (1999), To Err Is Human: Building a Safer Health System, (p. 1), Washington, DC: National Academy Press.

(2.) White, J.P., and Ketring, S.D. (2001) Framework For Approaching Patient Safety, Oklahoma City, OK: INTEGRIS Health.

(3.) Leape, L.L., and Berwick, D.M. (2000) Safe health care: are we up to it?, British Medical Journal. Vol 320, 18 March 2000, pp. 725-726.

(4.) van Leeuwen, D, Cholewka, PA., and Grube, JA. (2001) Do no harm, Journal for Healthcare Quality, Vol 23, No. 1, January/February 2001, p. 2, 24.

(5.) Leape, L. L. (1994) The preventability of medical injury, In M, S. Bogner (Ed.), Human Error in Medicine, (pp. 13-25), Hillsdale, NJ: Lawrence Erlbaum Associates.

(6.) Van Cott, H. (1994) Human errors: their causes and reduction, In M. S. Bogner (Ed.), Human Error in Medicine, (pp. 53-66), Hillsdale, NJ: Lawrence Erlbaum Associates.