Calling All Leaders
Deborah M. Nadzam, PhD, FAAN
Practice Leader, Patient Safety Services
Three reports were recently released about the quality of care and patient safety in our nation’s hospitals, representing data from three different sources and addressing three different aspects of quality and safety. The Agency for Healthcare Research and Quality (AHRQ) released its 2009 Comparative Database Report of the Hospital Survey on Patient Safety Culture;1 the Leapfrog Group issued a report summarizing the 2008 Leapfrog Group Hospital survey results;2 and AHRQ also released the National Healthcare Quality Report (NHQR)3 for 2008. All three of these reports acknowledge some positive gains in quality and patient safety, yet they emphasize the continuing concern about the slow pace of progress related to quality of care and safe practices and culture.
Whether or not your facility is included in the data behind these reports, you are certainly tracking external expectations related to quality and patient safety. The importance of leadership to patient safety and quality has now been emphasized by just about every stakeholder in health care, including regulators, accreditors, payors, purchasers, patient safety organizations and even practitioners. Leaders of health care organizations are expected to establish and maintain the culture of the organization, set priorities for improvement, remove barriers to safe quality care, provide support to staff, model behavior, and hold each other and their staff accountable. Quite a bit for one CEO or one suite of executives! It is true that the culture of an organization is driven by leadership and that the executives set priorities, define strategy, and provide resources and support to achieve the stated goals. There are three other groups of leaders to call upon to assist executives: members of the medical staff, supervisory staff, and informal leaders.
Medical staff engagement in quality and safety activities is no longer an option, nor is it sufficient. This is reflected in The Joint Commission’s leadership and medical staff standards that require medical staff leadership in quality and patient safety.4 In addition, the medical staff standards state that the organized medical staff must participate in organizationwide performance improvement activities, and that the credentialing process of individual members addresses the six areas of competencies adapted from the ABIM and ACGME, one of which specifically speaks to improvement of care. Recently, University of Massachusetts Memorial Medical Center described a comprehensive plan implemented to include physician leaders and other members of the medical staff in quality and safety initiatives.5
Supervisory staff within the organization hold formal management positions, affording them both the opportunity and responsibility to provide leadership to their staff. As “middle managers” they receive communications from the top and from the front line. They are the key conduits for sharing information, setting expectations, role modeling, rewarding desired behaviors and performance, and demonstrating vigilant attention to the quality and safety of patient care. Middle management has often been called one of the most difficult roles in any industry, as these managers juggle information from all corners and levels, while still needing to “get the laundry out.”
Informal leaders exist in every organization. These are individuals who do not occupy formal management positions, but have gained the respect and trust of fellow workers, probably as a result of the person’s performance, relationships with others, integrity, and demonstrated “standing up for beliefs.” Informal leaders can make or break organizational initiatives. Leaders need to acknowledge and communicate with informal leaders, sincerely seeking input and describing the organizational goals. To effectively work with informal leaders, executives must respect the informal leader’s relationship with colleagues and not attempt to sway the individual beyond his/her honest level of support and agreement. Once an informal leader is viewed as a formal leader, or too aligned with formal leaders, the power of informal leadership is diminished.6
There is plenty of work yet to be done to move health care to a higher level of quality and safety. And there are plenty of leaders in health care to get the job done. Calling all leaders – it’s time to step up the pace – working together for the benefit of patient results.
1
http://www.ahrq.gov/qual/hospsurvey09/
2
http://www.leapfroggroup.org/media/file/leapfrogreportfinal.pdf
3
http://www.ahrq.gov/qual/nhqr08/Key.htm
4
Joint Commission Comprehensive Accreditation Manual for Hospitals, 2009.
5
Walsh KE, Ettinger WH, and Klugman RA. (2009). Physician quality officer: a new model for engaging physicians in quality improvement. American Journal of Medical Quality, 24(4), 295-301.
6
Bacal R. Benefiting from informal leaders in your organization- communication the key. http://work911.com/leadership-development/articles/informalleadershipbenefits.htm
Accessed April 9, 2009.