with a commitment from an organization's executive leadership that
filters down to the OR in the form of actions staff can see, feel and
experience every day.
"There's no substitute for committed leadership that's ready to walk
the talk," says Dr. Rothfield, system vice president, chief medical officer
and chief quality officer at St. Vincent's Healthcare in Jacksonville, Fla.
"If we don't do that for our frontline staff, we run the risk of doing harm
to somebody."
One brick at a time
Creating a pervasive culture of safety might sound like a monumental
task, especially if you're starting from scratch. So don't try to solve
everything at once, says Mark P. Jarrett, MD, MBA, MS, senior vice
president and chief quality officer of Northwell Health, a New Hyde
Park, N.Y., health system that includes 21 hospitals and 500 ambulato-
ry sites.
"Culture takes a long time to change," says Dr. Jarrett. "To do it
effectively, you can't take on a project so it's fixed this week but next
week it's broken again. Build a better mousetrap by taking the time to
get at the root of the problem."
It could be fine-tuning time outs to prevent a wrong-site surgery. Or
analyzing the way you label lab samples to eliminate processing
errors. Or reviewing how and where you store medications to
decrease the likelihood of administering the wrong look-alike/sound-
alike drug. No matter the project, leadership should always involve
frontline staff to determine the most appropriate course of action.
"You can't do it by yourself," says Dr. Jarrett. "Besides, frontline staff
usually have better ideas because they live and breathe it every day."
His advice for tackling any safety-related project: Don't try to recre-
ate the wheel. Use existing toolkits from organizations such as the
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