Guest Editor: No Easy Path to Safety

Seek out problems through a systems-based lens with an ever-present awareness of the people those systems are meant to protect.

For healthcare providers, the shared primary goal is clear: Keeping their patients and their team members safe and free from harm.

Every leader prioritizes the safety of their patients and their staff, but even the most earnest, well-intentioned attempts to solve deep-seated problems often fall short when they fail to take a comprehensive, human-centered approach. Based on the work my organization has done with providers, there’s a misconception that safety issues can be resolved with solutions that rely entirely on behavioral changes — stricter policy enforcement, more regular training or increased education.

While all these things are an important part of a safety culture, the hard truth is you can’t educate your way out of a problem. For too long we have expected people to be perfect. They need to remember to do X,Y and Z in a system that may not be set up to completely support those activities. Humans aren’t perfect, and expecting them to act as such in an increasingly complex environment not only fails to mitigate risk, but adds to burnout. However, when facility leaders view safety problems through a total-systems lens — a system where the principles of safety science, just culture and transparent culture are consistently and uniformly applied — they see everything differently. The factors that contribute to harm manifest across the system, from the organizational culture to the physical work environment. That means impactful, sustainable improvements must come through a redesign of the entire work system. The tools, tasks and technology providers use must help them do their best work each day and not create barriers to safe care.

A true systems-based culture of safety is especially difficult in an outpatient setting, because when the patient arrives for a procedure, the treatment team is typically meeting them for the first time. In many cases, they are working with information from multiple systems and sources, which may have key information gaps. Still, with the procedures being performed in an outpatient setting becoming increasingly complex, the ability to overcome these challenges is more important than ever.

Achieving a culture of safety takes work; there’s no easy path or simple shortcut. There will always be problems to solve, but effective leaders know how to approach them. A good exercise is to look at your issues today versus the ones you faced one, two or even five years ago. If you’re dealing with the same things year after year, your organization needs to look at why these issues are repeating and commit to a systems approach to identify a sustainable solution.

Proven and emerging safety practices are driven by data. Of course, these numbers represent human beings. We must never lose sight of the fact that everything we do impacts people. I was lucky enough to have leaders early on in my career to drive this home. Later, seeing the impact on a family member who had the wrong implant placed during a surgical procedure only reinforced my commitment to keeping the patient at the center of everything I do. When presenting data to staff, layering in the human element is one of the most important actions leaders can take. Present the statistics, yes, but find a way to remind staff of the patient impact. If infection rates decrease from 1.5% to 0.9%, that’s good from data a perspective — but it’s also good because it means fewer people will be negatively impacted by the additional doctor visits and longer recovery times that accompany an SSI.

In this Special Edition of Outpatient Surgery Magazine, you’ll read about the latest safety systems to prevent everything from common occurrences such as sharps injuries to never events like retained surgical items. At the heart of each story, however, there remains a fundamental respect for the two most important elements of it all: the patients and the providers who care for them. OSM