The link between leadership commitment to safety and better outcomes for patients is both well-understood and well-established. Accordingly, the Roadmap to Health Care Safety for Massachusetts, a multi-year strategic plan developed by the Massachusetts Healthcare Safety and Quality Consortium and the Betsy Lehman Center, highlights the role of leaders at all levels in governance and the workforce.

“Vertical integration of leadership has to happen at a grassroots level at every practice,” said Ted Calianos, M.D., President of the Massachusetts Medical Society. He noted that every physician practice, whether owned by a solo practitioner or a large health system, has local, de facto leaders who establish and model the culture of the workplace for each team and location.

Dr. Calianos’s remarks were echoed by other health care leaders and expert panelists at last month's Massachusetts Health Policy Forum, organized by Brandeis University’s Heller School of Social Policy and Management, during which the Roadmap was introduced.

Leadership is the first of the Roadmap’s five goals

The first of the Roadmap’s five long-term goals calls on leaders of organizations across the care continuum to “make safety a core value and enduring priority, continuously act to advance safety culture and operations” and to be held accountable for safety performance. Recognizing that “all provider organizations have leaders — from the owners of small office practices and clinics to the chief executive officers and board members of large hospitals,” the Roadmap includes strategies and action items that can be adapted to the needs of different care settings.

The plan acknowledges that health care leaders are currently addressing numerous challenging issues — including racial inequities, workforce shortages, workplace conflict — and anticipates that the framework on which the Roadmap is built can help address these issues while improving care delivery.

Panelist Christine Schuster, R.N., Chair of the Board of the Massachusetts Health & Hospital Association and President and CEO of Emerson Health, underscored the role played by organizational leaders as well members of the hospital’s Board of Directors in transforming current approaches to safety improvement.

At Emerson, she said, board members receive training on high reliability principles and are invited to participate in hospital rounds so they can interact with frontline staff and, sometimes, patients. Their participation in safety rounds is a “force multiplier,” she said, adding, “That enthusiasm takes off … We have a board quality committee that wants to meet all the time.”

Panelists agreed that individuals who serve on health care organization boards can model and foster organizational culture, learn safety principles to better evaluate their own organization’s performance, and support safe care through prioritization and resource allocation. Michael Curry, Esq., President and CEO of the Massachusetts League of Community Health Centers, noted that consumers constitute more than 50 percent of membership on community health center boards. It helps, he said, to have people who receive care at the centers actively helping to drive policy and improvement.

Dani Hackner, M.D., Physician-in-Chief for Medicine at Southcoast Health, highlighted the Roadmap’s recommendation for stronger education on safety at the leadership and governance level so that all can be “proficient, confident and empowered to speak up” about safety. Dr. Hackner also emphasized the need to applaud achievement, one of the strategies in the Roadmap’s leadership goal, saying, “We need to recognize individuals when they achieve, whether they're in our [environmental services] department or on our board.” He went on to say, “And then we also need to reward exemplary performance of provider groups, health organizations and hospitals in financial ways.”

Most important, said Maryanne Bombaugh, M.D., who practices at a community health center on Cape Cod and is the Immediate Past President of the Massachusetts Medical Society, leaders drive the culture within any workplace, and in health care settings, a culture of safety is paramount.

“In a culture of safety, leaders establish trust, show respect, promote inclusion with the health care workforce and patients and families,” she said. “Trust, respect and inclusion are also non-negotiable standards for the boardroom, clinical departments, offices and the entire workforce.”