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


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