Knowledge to Practice observes Patient Safety Awareness Week 2020


Mark Chassin, MD, FACP, MPP, MPH, president and CEO, The Joint Commission, was a member of the IOM’s Committee on Quality of Health Care in America, which wrote To Err is Human: Building a Safer Health System in 1999. In November 2019, Dr. Chassin reflected on the accomplishments of the past 20 years and emphasized the importance of the leaders of healthcare organizations to commit to “zero harm” in these 2 ways:

Creating an organizational culture of safety

Leaders of healthcare systems and hospitals are encouraged to create a culture in which (1) all staff feel empowered to speak up and raise concerns and safety and quality of care and (2) all staff are held accountable for 100% adherence to safety protocols and best practices.

In observance of Patient Safety Awareness Week, K2P spoke to four professional leaders who play different roles in patient safety. Below is our discussion with Deborah Small, MSN, DNP, Chief Nursing Officer at Cleveland Clinic, London.

Deborah Small, MSN, DNP, Chief Nursing Officer

We first spoke to Deborah Small, MSN, DNP, Chief Nursing Officer at Cleveland Clinic, London.
Deb has had the opportunity to lead the operations of nursing departments in various types of organizations- from a rural community hospital to a system the size of the Cleveland Clinic. She is currently leading the clinical operation at the Cleveland Clinic in London, scheduled to open in 2021.

What opportunities do you have to influence future patient safety in your current position, when you are truly involved on the ground floor?

Building a new hospital provides the opportunity to better understand the complexity of the work environment and engage in strategies to make early safety improvements. For example, we are developing each policy and care path to assure we have the latest evidence-based practice incorporated to standardize processes and decrease variation in practice.

What do you think are the biggest challenges to the delivery of safe patient care?  

I think the 3 biggest safety challenges for nurses are feeling empowered to “speak up” for safety, lack of appropriate resources and workforce shortages.   

As a leader, what measures do you take to assure nursing staff feel a sense of empowerment and confidence to speak up when they feel that patient safety may be at stake?   

Establishing the “speak-up culture” starts with relationships and establishing a culture of trust. Assuring competency, knowledge and teamwork are key to supporting the confidence of each nurse to raise issues and ask questions. Incorporating “huddle” concepts and escalation protocols promote the encouragement of staff to speak out and share concerns.

Can you give an example of how an observation voiced by nurses led to safer, higher-quality care?

We should not be surprised that nurses have the most amazing ideas to improve care and safety!  One of my most recent examples, before I came to London, is the automation of frequent rounding on the mental health unit. At the suggestion of staff nurses, we leveraged technology-driven workflows, eliminating guesswork, and leading to regular frequent rounding to improve patient safety.