Ron Walls discusses the role patient safety plays in the Brigham’s strategic priorities.

You wouldn’t choose an airline that tries to attract customers by saying its planes are safe most of the time. Safety is an expectation no matter whose flight you’re on, while updated aircraft, expert and supportive cabin attendants, and a streamlined boarding process are what set apart one airline from another.

The same expectation needs to be set regarding patient care at BWH, said Ron M. Walls, MD, BWHC executive vice president and chief operating officer, speaking at a Quality Rounds presentation, “Delivering High-Quality, Safe Care: A Strategic Imperative” in Bornstein Amphitheater on April 21.

Although two of the strategic priorities the hospital has established—scalable innovation and advanced, expert care—distinguish BWH as a leader compared to other institutions, these priorities cannot be achieved without a strong foundation of excellence in safety, quality and patient experience, Walls explained.

“Delivering the highest-quality safe care and providing an exceptional patient experience are as critical to the hospital’s existence as food and water are to our personal existence,” he said.

The Brigham has long held a reputation for safe, high-quality patient care, but there is an ongoing requirement for improvement. According to Walls, this hinges on staff embracing safety and quality as part of our patient care culture, and making them part of every thought and action.

“Safety and quality are completely interwoven,” he said. “They’re not a series of programs that you add onto or integrate into things—they require a culture of collective and personal responsibility and accountability.”

Shifting Focus

This hospital is supporting efforts to consistently achieve safe, high-quality care for our patients by focusing on three key areas: increasing transparency, creating a Just Culture and improving communication and resolution after a medical injury.

In terms of transparency, BWH goes beyond the minimum reporting requirements by disclosing not only the number of serious reportable events, but also the narrative that goes with them. The hospital’s Safety Matters blog is one place where this happens, detailing errors that have occurred and what has been changed to prevent them from happening again.

Traditionally, health care providers have only scrutinized errors that resulted in harmful outcomes, but incidents that don’t appear to cause immediate harm need to be treated equally seriously, Walls said.

“Our focus has shifted from being compliant with market and regulator expectations, in terms of safety disclosure, to being leaders in transparency,” he said. “We’re telling those stories to shine a light not only on the incidents so others can learn from them, but also on ourselves so it’s clear to us and everyone else that we hold ourselves to the highest safety standard.”

That’s why fostering a Just Culture at BWH is so important. A Just Culture abandons a “blaming culture” where people are afraid to voice concerns or report mistakes for fear of punishment.

“There is always a need for individual accountability around safety,” Walls said. “But if the person who makes a mistake is being careful and acting in a reasonable way, and our systems facilitate the error, then we must correct the systems and support the person.”

Clinicians should do more than just disclose and apologize for such errors to patients. In fact, it is best to work with the patient to identify what would be necessary to make the situation right. This latter step might include an offer of compensation, a significant departure from traditional approaches, he added. These practices are necessary to achieve resolution after a medical injury.

Walls expressed empathy for the fear that patients and their families can face when interacting with a hospital, stating, “Our job is to communicate with them openly and honestly, and to treat them with respect so that we can establish trust and alleviate their fears.”

View the Quality Rounds webcast here. (This link is available only to Partners employees.)