The Healthcare Executive's Role in Ensuring Quality and Patient Safety
November 2012 (reaffirmed)
Statement of the Issue
Providing safe, high quality patient care always has been a focus of healthcare executives. However, the Institute of Medicine’s (IOM) landmark report, To Err Is Human, Building a Safer Health System, issued in November 1999, was a clear indication that efforts needed to be intensified. The report laid out a comprehensive strategy by which government, healthcare providers, consumers and the industry as a whole could reduce preventable medical errors. Since the original IOM report, organizations such as the Agency for Healthcare Research and Quality (AHRQ), the Institute for Healthcare Improvement (IHI) and The Joint Commission have focused on developing and promulgating best practices to improve patient safety. Particularly visible have been IHI’s 100,000 Lives campaign followed by its Five Million Lives campaign.
The IOM report noted that the majority of medical errors do not result from individual recklessness or incompetency. Rather than a “bad apple” problem, the report concluded that errors are commonly caused by “faulty systems, processes and conditions that lead people to make mistakes or fail to prevent them…Thus, mistakes can best be prevented by designing the health system at all levels to make it safer—to make it harder for people to do something wrong and easier for them to do it right” (Report Brief, To Err Is Human: Building a Safer Health System, p.2).
Awareness of the prevalence of patient safety and quality issues has contributed to greater scrutiny from regulators, purchasers and the public. Whether in the form of consumer assessments (e.g., CAHPS) or various publicly available quality indicators, expectations for transparency are increasing. Both government and private payors also have begun to align payment and quality/patient safety by piloting pay-for-performance systems and adopting zero payment policies for “never events”—serious reportable events, such as wrong-site surgery, that never should occur.
Improving quality and eliminating errors requires executive leadership and the board to guide an organizational culture dedicated to improvement, focusing resources on the structures, processes and monitoring systems that will ensure patients receive the care they need without risk of harm. While specific components of a patient safety and quality strategy will vary by organization, the American College of Healthcare Executives (ACHE) believes healthcare executives should lead a comprehensive approach to ensuring patient safety and quality, including:
- Equipping the board with tools and information to provide appropriate oversight of the patient safety/quality strategy.
- The board of a healthcare organization has the responsibility of overseeing progress toward achieving organizationwide goals for patient safety and quality. The establishment and review of improvement goals and safety/quality indicators should be regular components of the board’s agenda.
- Involving the entire executive leadership team in the patient safety/quality strategy.
- The CEO, together with the other members of the senior leadership team, should establish and monitor an executable strategy for setting and achieving patient safety/quality goals. That strategy should include clear metrics to determine progress and guide necessary adjustments.
- Engaging the medical staff as meaningful partners in the development and implementation of the patient safety/quality strategy.
- The patient safety/quality strategy, implementation plan and metrics should be developed with meaningful involvement of medical staff in a manner that effectively and efficiently uses their time and expertise.
- Developing processes to hear the voices of patients and families and applying their input in the design and improvement of care processes.
- Creating a patient-centered culture has been shown to improve outcomes and patient satisfaction while reducing errors and costs. Healthcare executives should design reliable methods to collect and use patient and family input.
- Cascading a patient safety/quality orientation throughout the organization.
- The patient safety/quality strategy should involve building improvement capacity throughout the organization, creating an organizational culture and sustained process for furthering clinical quality, and eliminating errors that negatively impact patient safety.
- Developing a culture of improvement that includes an organizationwide commitment to continuous learning.
- Investment in human capital is critical for growing the capacity necessary for executing patient safety/quality initiatives and establishing a culture of improvement. Ongoing education should involve change leadership knowledge as well as specific techniques for identifying, implementing, monitoring and sustaining improvement opportunities.
- Rigorously seeking out and applying best practices.
- Well-defined, evidence-based practices, such as those promulgated by the AHRQ, are replicable across healthcare organizations and have been shown to lead to improved outcomes. The use of such established best practices should be a key component of an organization’s patient safety/quality strategy.
- Providing open communication and demonstrating a commitment to transparency.
- Achieving ongoing, sustained improvement in patient safety and quality requires a commitment to frequent and open assessment of data by all relevant participants within a healthcare organization. In addition, the reporting of results and meeting public and stakeholder expectations for transparency should be incorporated as part of the patient safety/quality strategy.
- Adopting information systems that support the patient safety/quality strategy.
- Information systems play an important role in structuring processes so that appropriate decisions and actions occur. The patient safety/quality strategy should include the adoption of information systems demonstrated to facilitate improved outcomes such as computerized physician order entry with clinical decision support.
- Encouraging organizational involvement in voluntary collaboratives.
- Participation in voluntary collaboratives among providers and other interested parties can provide a valuable forum for comparing data, sharing best practices, stimulating improvement efforts and increasing transparency. To the extent that a relevant collaborative exists for an area served by a healthcare organization, active participation is encouraged.
Improving patient safety and quality involves leadership by the board and CEO based on an executable strategy cascading throughout the organization. The leadership actions recommended by ACHE in this policy statement represent core building blocks for such a patient safety/quality strategy. It is incumbent upon healthcare executives to implement and expand upon these elements as they strive to eliminate errors, continuously improve the quality of healthcare services and better serve the patients entrusted in their care.
Approved by the Board of Governors of the American College of Healthcare Executives on November 12, 2012.