AUSTIN, Texas — Dressed in a patient gown, old admission bracelets from past hospital stays dangling at her side, Kim Blanton held up a piece of paper with a gnarly black spot in the middle. "What do you see?" she asked.

Most in the room full of patient safety professionals saw the spot, of course. But Blanton, who is a patient and family advisor at Vidant Health in North Carolina, implored them to think differently. Hospital leaders and clinicians must start to see beyond the conditions they think define patients, she told attendees at the National Patient Safety Foundation Congress. Set aside those biases and see the whole picture (or piece of paper) — a person willing to help better your organization, not just a problem waiting to be solved.

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"This paper represents that patient; that spot's just a diagnosis," Blanton said. "If you recognize this paper, you will understand that a patient has more to offer you than what you're treating, and I really want you to take advantage of that. Until health care starts looking at the paper and not just the diagnosis, we're not going to improve."

Blanton was one of three patient and family members, all with trying experiences in the health care system, who spoke during a keynote speech Thursday afternoon. Hospitals have made tremendous strides in the patient safety movement, and yet, more than 15 years after To Err is Human, horrific mistakes are still occurring.

Beth Daley Ullem described how a perfect storm of errors and neglect at a Chicago-area hospital several years ago resulted in the death of her newborn child. She was willing to give back the subsequent $4 million settlement to help that institution improve its safety practices, but leaders refused. Since then, she's led a crusade to eliminate harm in the industry, now serving on the board of directors at ThedaCare Hospital System and board of governors at the NPSF.

She believes that, if hospitals are serious about changing their safety cultures, their trustees need to tie executive compensation to avoiding patient harm.

"It kind of stops in the CEO or CMO world. You need to take it to the boardroom because a lot of these hospitals are still compensating their CEOs just on financial margin," Daley Ullem said. "Ultimately, you're not going to have traction and commitment to safety if you're not compensating towards safety."

Similarly, Chrissie Blackburn stressed the C-suite's key role in addressing safety issues within a hospital or health system. At University Hospitals of Cleveland, where she's principal advisor on patient and family engagement, they've let health care users lead safety initiatives, and placed them adjacent to the top executive in the chain of command.

"It's made a tremendous difference in the reporting structure that I have, which is directly to the C-suite, because we've been able to drive that change much more quickly instead of someone being meddled in the middle of middle management," Blackburn said. "When I have a question I go right to the chief, and it's helped a lot."