As nearly half of healthcare workers nationwide report low safety culture, New York City-based NYC Health + Hospitals is moving in the opposite direction.
The system’s 2026 employee engagement survey found safety culture scores increased 9% at acute care facilities and 10% at post-acute care sites compared to the prior survey, according to Hillary Jalon, a senior vice president at the system and its chief quality officer. Response rates also climbed.
She attributed the results to years of intentional work building quality improvement capacity at every level of the workforce.
“In order for performance improvement to thrive, you need to have a culture of safety,” Ms. Jalon told Becker’s.
The survey responses reflect work Ms. Jalon said is foundational: embedding psychological safety, reinforcing a non-punitive reporting culture and reinvigorating just culture principles. The system also uses a non-punitive root cause analysis framework called RCA2 (pronounced RCA squared) and is supporting TeamSTEPPS — a team-based patient safety model — across the entire system.
At the center of that capacity-building effort is the Quality Academy.
NYC Health + Hospitals launched the program in 2022, and the premise is straightforward: Anyone can apply, Ms. Jalon said. Physicians and nurses participate alongside hospital police, environmental services workers, patient care associates and behavioral health aides. Chief quality officers at each site run the program with facilitators.
“Those that do the work are the most well positioned to improve the work,” Ms. Jalon said.
The academy’s reach extends beyond the system’s acute care hospitals to post-acute care sites, MetroPlus (the system’s health plan), correctional health services, the community care division and the ambulatory care division.
The goal is succession planning, or what Ms. Jalon calls developing the next generation of improvement leaders across the system. The result has been a surge of performance improvement projects driven by front-line staff who understand the problems firsthand.
Ms. Jalon credited predecessors, including former Chief Quality Officer Eric Wei, MD, with building the cultural foundation her team has built upon since she joined the department about eight years ago. Looking ahead, the department plans to launch a best practices sharing forum before year’s end to help sites learn from each other’s improvement work.
Sustaining improvement gains, Ms. Jalon said, remains one of quality’s persistent challenges. Momentum can fade as teams shift focus, and progress that took months to achieve can erode.
“A lot of times what happens in quality improvement is we start off really heavy with great momentum, and then people either get tired of the topic or they move on to the next thing, and then all the improvement gains go away,” she said.
To counteract that, every project at NYC Health + Hospitals carries a balancing measure — a secondary metric tracked to ensure improvement in one area does not cause regression in another. For example, a project focused on reducing catheter-associated urinary tract infection rates will also track central line-associated bloodstream infections.
“Let’s say you have an aim to reduce CAUTIs. We might want to pick a balancing measure to make sure: Am I, because I’m focusing on reducing CAUTIs, inadvertently increasing my CLABSIs?” Ms. Jalon said. “We review our CLABSIs as our balancing measure to make sure we stay steady.”
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