The subject came up in a meeting as a result of a query about a recent Joint Commission sentinel event alert presenting 11 tenets of a culture of safety, and ways managers can implement them.

 “The Joint Commission sentinel event alert was not a surprise,” said Rusty Holman, M.D., chief medical officer for the rural-focused LifePoint. “The Joint Commission has been very focused on helping organizations facilitate and promote quality and safety, and in particular focusing on leadership.”

LifePoint, based in Brentwood, Tenn., has been consciously working to regularly strengthen its culture of safety and doing so in a systematic fashion, meaning it’s not as touchy-feely or personality driven as one might think.

“We have found the most progressive health care organizations regard culture as something that you define and that you can measure, and that you can also manage,” Holman said. “We don’t want to leave it [culture] to chance, and we don’t want it to evolve on its own.”

As a result, LifePoint conducts a survey of its 72 hospitals every 18 months — the quickest it can do so — seeking out stories of how safety can be improved. The surveys are used to help unearth problems and figure out ways to fix them.

Holman says it is a tough-to-manage process, because asking about a problem might create more problems if nothing is done to correct it. Moreover, within a hospital, culture might vary widely, meaning the issues raised might require a different response from department to department.

LifePoint built its focus on leadership and culture as part of its Hospital Engagement Network overseen by the Centers for Medicare & Medicaid Services.

The HEN program also proved to be successful for the American Hospital Association, which currently is involved in a follow-up quality improvement vehicle  called a Hospital Improvement and Innovation Network.

LifePoint created three pillars of patient safety as a result of its HEN, one focused on leadership in the hospital and on the board, one on culture and a third one on process improvement.

“We wrap it all together by making sure that everything we do is patient-centered,” Holman said. Much of that work is by bringing patients and their families into the hospital to help.

“We have a very significant set of means by which we engage the patient’s voice and the family’s voice, not only in their own care but the design of care itself,” Holman says.

“That has been very, very successful for us as well.”