Many patient safety initiatives are missing a key component that can mean the difference between long-term change and abandoned projects: executive follow-through.
“Patient safety is not an initiative problem in American healthcare,” Kriti Shree, a healthcare performance improvement and transformation leader at Baltimore-based University of Maryland Medical System, wrote in a Sept. 16 op-ed published in Becker’s. “It is a follow-through problem. The hospitals that lead this field over the next decade will be the ones that stop confusing the two.”
Executive attention is highest at the launch of patient safety programs but often fades after six months, “when the harder work of embedding the change into daily operations actually begins,” Ms. Shree wrote. Sustainable culture change in a clinical workforce takes 12 to 24 months of reinforcement, but most safety launches assume six, she wrote. Frontline staff notice when leaders’ attention shifts, and it shapes how they engage with the next initiative.
Nearly 47% of healthcare workers report low safety culture perceptions, with lower ratings among clinical staff. However, the units with strong alignment between front-line staff and senior leadership show stronger reporting cultures and higher safety outcomes performance. Among organizations in the top decile for employee engagement, three of the five largest performance differentiators relate to confidence, trust and respect in senior leadership.
Organizations that encouraged speaking up, reminding, accountability and challenging assumptions were 2.5 times more proactive regarding patient outcomes and care quality.
Improving executive follow-through, and by extension patient safety, starts with the small and consistent actions executives take, Ms. Shree said, such as designing initiatives with frontline staff, setting timelines that match how long it takes clinical culture to change and reviewing safety data with the same discipline as financial data.
“None of this requires proprietary technology. None of it requires an academic medical center’s resources,” Ms. Shree said. “It requires executive follow-through, which is the one thing no framework can supply.”
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