Building a culture of safety is an enduring commitment that health care organizations embrace to achieve the highest levels of quality. It requires that caregivers, medical staff, and leadership interact with patients and one another to provide care systematically in the most effective manner.

The Comprehensive Patient Safety Leadership Fellowship, created in 2001 by the American Hospital Association and the National Patient Safety Foundation, helps organizations embed evidence-based practices and inspire change. To date, 322 health care professionals representing 188 organizations have participated. Saint Francis Hospital and Medical Center in Hartford, Conn., and Valley Hospital in Ridgewood, N.J., are leveraging CPSLF participation of multiple leaders to improve patient safety.

Shared Learning and Complete Participation

Patient safety culture has shifted, says David E. Shapiro, M.D. "It's not simply about process anymore; we must focus on outcomes, value and safety." Saint Francis' associate director, trauma and critical care, Shapiro was in the 2011-2012 CPSLF class. His action learning project — a key component of the fellowship — focused on decreasing ventilator-associated pneumonia in the ICU. "Ventilator bundles are clearly defined, but hospitals don't adhere to them," Shapiro observes. After determining bundle compliance was low, Shapiro's department educated staff and made sure that everyone was on the same page and aware of results. Saint Francis posts infection rates on units.

Getting rid of the hierarchy concept is important, Shapiro believes. "It's impossible to have success without complete participation and cooperation from the board, administration, nurses, physicians, custodial and ancillary staff. We're providing exceptional care at every level," Shapiro asserts. Saint Francis encourages staff to participate in multiple endeavors, including the CPSLF. "A hospital has to send key people who not only evolve as agents for change, but also set a good example," Shapiro suggests. Four Saint Francis employees have participated in the CPSLF.

Total Engagement and Culture Transformation

In northern New Jersey, Valley Hospital had a blip up in medication errors one month in 1995. Michael Mutter, director of patient safety, reviewed reports and realized "there was no analysis of the reports, just numbers." This event became one of the hospital's turning points. "Our culture needed to change if we were to believe information is knowledge and encourage staff to report occurrences rather than fear reprisal," he explains.

Mutter and two colleagues participated in the CPSLF's second class. The experience provided coaching from top-notch faculty and a network of fellows "who were living and breathing the same situations we were, whether it was dealing with personality types, overcoming silos or learning how to work through challenges," Mutter observes. "We learned a language to speak when dealing with the same problems."

Valley's performance improvement committee transformed from six or eight people to 60 or 70 people attending standing-room-only meetings. Staff would listen to presentations and say, "We want to do that in our unit." Valley now has seven teams that meet monthly and annual performance improvement days to share projects. "It's important to recognize, teach, bring out your message and post your work in public areas," Mutter says. The 17th and 18th Valley staff members are current CPSL fellows.

Cynthia Hedges Greising is a communications specialist at the Health Research & Educational Trust and Shawn Foster is manager of fellowships at HRET. For more information about CPSLF, visit www.ahafellowships.org.


WEB RESOURCES

Results of diversity survey
"Diversity and Disparities: A Benchmark Study of U.S. Hospitals," recently released by the Institute for Diversity in Health Management and the Health Research & Educational Trust, highlights hospitals' strategies to reduce health care disparities and increase diversity in leadership and governance. In 2011, the institute commissioned HRET to survey hospitals on their approaches to providing equitable care. A summary of the results, this study will help hospitals as they continue working to improve quality of care for all patient populations and expand leadership diversity. Go to www.hpoe.org/diversity-disparities.

Report on ACO readiness
HRET recently surveyed hospitals to assess their readiness for the development of ac-countable care organizations. "Hospital Readiness for Population-based Account-able Care" gives a snapshot of the state of the field and provides hospital leaders with a tool for assessing their organizations' current capacity to engage in ACOs. It is the first report to describe participation of hospitals in ACOs and their current capabilities. Support was provided by a Commonwealth Fund grant. For more information, visit www.hpoe.org/accountable-care.

Health care leader insights
To commemorate the 10th anniversary of its TRUST Award, HRET has released "TRUST: Meeting Our Mission 2003-2012," featuring remarks by past recipients. David Lawrence, Don Berwick, Brent James, Gail Warden, Janet Corrigan, Bob Brook, David Satcher, Glenn Steele, Atul Gawande and Maureen Bisognano share insights on team-based care, innovation, controlling costs, quality and end-of-life care, among other topics. HRET established the TRUST Award to honor individuals who have made significant and lasting contributions to health care. Recip-ients share HRET's vision of creating a society of healthy communities and its mission of transforming health care through research and education. For more information, visit www.hret.org/trust.