That was the thrust of Tuesday's keynote remarks at the Institute for Healthcare Improvement’s 28th annual National Forum on Quality Improvement in Health Care. Patient safety fatigue and burnout can sometimes set in for physicians and nurses, when they feel as though they are stuck in a hamster wheel of one improvement project after another with no end in sight.

Derek Feeley, IHI president and CEO, says that’s why it’s important to develop a system of safety so that we’re not playing whack-a-mole and bopping each new ugly problem when it pops up. In the new “Safety 2.0,” Feeley also believes that hospital leaders must foster the successes in their organizations, rather than relentlessly chasing the bad.

“I want to be clear with you that I do believe in learning from mistakes. I’m in favor of that,” he told the 5,000 or so in attendance. “It does, however, seem to me to be necessary, but not sufficient. You don’t have to fail to learn, and I’m not convinced that a system built to avoid mistakes is going to outperform a system that is built for reliable success.

“I put my hand up as a former chief executive and confess that I spent too much of my time trying to find the bad apples and not enough of my time nurturing the whole orchard,” he added, referring to his time as head of the national health care system in Scotland.

Scots’ love New Year’s resolutions, according to Feeley, and, as such, he offered attendees a list of six items to tackle in 2017 to begin making this patient safety paradigm shift:

  1. Learn from what goes right, as well as what goes wrong.
  2. Move from reactive and responsive to proactive and generative.
  3. Invest in safety systems for learning, rather than just individual safety projects.
  4. Shift away from fear, blame and liability toward humility, trust and transparency.
  5. Stop feeling as though you have to keep individuals you serve safe and, instead, begin to co-produce safety with patients and their families.
  6. Understand that safety is more than just the avoidance of physical harm, but also the pursuit of dignity and equity.

That last item is a key focus for IHI, with more than a dozen sessions tied to equity of care at this year’s forum. Feeley believes that if providers fail to treat patients with dignity and empathy, then they’re doing just as much harm to those they serve, even if it isn’t physical.

Failing to treat those of different races or economic backgrounds equally amounts to harm, and should be considered in the scope of safety improvement, Feeley said. Attendees have heard numerous examples here at the forum of innovations in the field to help do so, be it through letting impoverished patients administer antibiotics in their homes, to using mailmen to check in on the elderly.

Feeley closed with the example of the city of Seattle struggling to keep up with burned-out streetlights. Previously, residents were supposed to report blackouts, but this inevitably led to the better neighborhoods getting more attention. Now, the city just replaces all lights every two years, which is the average life of a light bulb. Can health care create similar structures to equally treat all individuals it serves?

“When you come up with systems that work better for the most vulnerable, you come up with systems that work better for everyone,” Feeley said.