It has been 25 years since the Institute of Medical Research’s Human Report reported that shocking losses caused by medical errors in the United States. That moment finally pushed quality and safety to a national dialogue. The response was quick. The entire organization is about solving this problem. For many of us in healthcare leadership, patient safety becomes our professional North Star.
Yet, a quarter century later, we are still insufficient here.
Medical errors are the third largest cause of death in the United States, claiming more than 250,000 lives each year. Despite all the awareness, infrastructure and speech, we have not made the progress we deserve.
The reason is simple: leadership. Or rather, lack of leadership focus and follow-up. Patient safety has been lost in the priority list. Safety efforts rarely take root without the strong concern of the highest person.
Safety cannot be ranked sixth in priority
After the IOM report, no healthcare executive dares to say that safety is not the top priority. It usually appears in the form of the first or two in leadership surveys. Today, this has changed. Finance, staffing, compliance and margin control have raised priority lists. Patient safety didn’t even show up in the top five in the recent survey of hospital CEOs by the U.S. School of Healthcare Executives.
This shift is not only disappointing—it is dangerous.
Zero should be the target
Too many tissues talk about reducing the gradual reduction of hazards: cutting is reduced by 2%, slightly lowering infection rates, or improving patient experience scores smaller. These goals may meet regulators, but they missed the point.
If the hazard is preventable, the only acceptable target is zero.
This is what high reliability organizations think. The airlines and the nuclear power industry show us that a culture of commitment to safety, supported by discipline and standardization, can almost eliminate flaws. Yes, health care is biologically complex – but it is not an excuse to tolerate mutation or preventable harm.
We will never be perfect, but it is possible for us to behave like zero. Send fewer error messages.
It starts at the top
The Council sets the tone for the entire organization. If quality and safety are placed at the bottom of the board agenda, that is exactly the priority list they will belong to each leader.
When I was CEO of a large health system for a large health system (now called Brown University Health), safety was my top priority. We incorporate safety into incentive programs, job descriptions and performance evaluations – not only for clinical staff, but also for administrative teams. We simplify the task statement into four words: Provide health with caution. This clarity helps every employee understand their role in creating a safe environment.
Culture is what you do, not what you say
Building a safety culture is not about slogans or posters in the lounge. It's about how people work, how they communicate and how they solve problems together. When we negotiate with organizations experiencing security failures, the root cause is often a dysfunctional team. Poor communication, lack of trust or self-evident conflict can lead to mistakes.
Medicine is a team sport. When the team works well – patients do better when they speak out, support each other and take on shared responsibilities. It sounds simple, but it's not easy. A clear leadership is required every day.
Don't treat safety like a side project
The unsettling trend is the integration of executive roles. In some hospitals, the same leader serves as the hospital’s president, chief medical officer and chief quality officer. This doesn't work – it's the secret to missing the problem.
Security requires centralized leadership – not someone who spreads too thinly, or only mentions security in quarterly comments. Someone must be present – on the floor, in the meeting and in the trenches – asking the frontline staff about what doesn't work and follow. This is the change in the drive.
Security is not only moral – it's smart
Safe care is effective care. It reduces readmissions, avoids waste and improves morale. It builds the trust of the patient. Yes, it protects the bottom line. However, if leaders view security as line items rather than core values, it doesn't matter.
What about 6% of patients if the hospital lowers its fall rate to a target of 6% and declares a victory? They are not statistics. They are the suffering people.
Leaders must link data to human costs. That's not enough to reach the number. We have to continue asking, “We are still failing?”
Leader's phone number
Since the pandemic, health care systems have become increasingly fragile. A closer budget. Burnout is higher. But this is the most important moment for leadership.
The board must retake its supervisory role. The CEO must re-place security over its priorities. Every leader in an organization must see quality and safety as part of their work – because that's.
We spent 25 years talking about security. Now is the time to lead as we mean.
Photo: z_wei, Getty Images
Dr. Tim Babineau is a respected clinician, executive and strategist who has served as both a surgeon and executive director of health systems for nearly 40 years. Dr. Babineau works throughout healthcare in his role as Chief Physician Consultant at ECG, from the frontline to C-Suite to the management committee’s clients.
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