1. Leadership With Accountability (Avoiding Financial Penalties)
Ana M. Hands, M.D.
Vice President
International Health &
Transplant Services

2. The Definitions Leadership:
The development of vision, strategies and alignment of relevant people behind those strategies and empowerment of individuals to make vision happen despite obstacles
Accountability:
The obligation of an individual or organization to account for its activities, accept responsibility for them, and to disclose the results in a transparent manner
Leadership can be hard to define and it means different things to different people. In the transformational leadership model, leaders set direction and help themselves and others to do the right thing to move forward. To do this they create an inspiring vision, and then motivate and inspire others to reach that vision.

3. The Basics
What separates the good, the bad, and the ugly are attributes such as vision, culture, communications, goals, integrity, knowledge, training, and accountability, to name a few important qualities

4. Top Issues Facing Healthcare
Governmental Mandates
Patient Safety and Quality
Patient Satisfaction
Physician-Hospital Relations
Technology
Personnel Shortages
Creating an Accountable Care Organization
Financial challenges

5. Top Issues Facing Healthcare
Will
Cost Money!!!
Governmental Mandates
Patient Safety and Quality
Patient Satisfaction
Physician-Hospital Relations
Technology
Personnel Shortages
Creating an Accountable Care Organization
Financial challenges

6. Patient Safety

7. The Headlines

8. Patient Safety Issues Inpatient suicides medication errors,
wrong site surgery,
restraint injuries,
elopement,
falls,
retained foreign objects,
delay in diagnosis,
Infant abduction
communication errors/ Misdiagnosis
transfusion errors,
surgical site infection,
Heparin /Warfarin complications,
critical lab results,
skin tears
infections like MRSA and VRE,

9. Patient Safety
Having a non-punitive environment would encourage reporting of errors and near misses
Both the Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS) require a non-punitive environment
A person who is reckless or does something intentional to harm a patient should be terminated from employment

10. Safety Culture
The concept of safety culture started in areas outside of healthcare such as the airline industry
The studies look at high reliability organizations
Thee are organizations that were complex and hazardous yet they were able to minimize adverse events
These organizations maintained a commitment to safety at every level
The hospital must have organizational commitment to establish a culture of safety

11. Safety Culture
Hospitals need to be proactive to prevent harm from occurring instead of being reactive and doing something once a patient is harmed
Patient safety needs to be viewed as a strategic priority
The entire hospital needs to be focused on patient safety if a culture of safety is to be established
A safe culture is evidenced by employees who are guided by the organizational commitment and where safety standards are upheld on a personal and team level

12. Safety of Culture
There needs to be visibility among senior leaders to front line staff
How many hospitals leaders do patient safety rounds or walkabouts?
Strategic planning of patient safety is important
There needs to be greater education of physicians about safety efforts
Many physicians did not report adverse events
See Evaluation of the culture of safety: survey of clinicians and managers in an academic medical center. Pronovost PJ, Weast B, Holzmueller CG, et al. Qual Saf Health Care. 2003;12:

13. Safety Initiatives
Hospital in the study had a patient safety committee
This committee created a safety mission statement
Developed a non-punitive error reporting policy
Created information sheet of safety tips for patients and families
Educated staff on the science of safety and how to disclose errors
Developed a safety intranet site to share stories on patient safety
Implemented senior safety walk abouts

14. 1000 480 Negligence Injuries Filling Claims All Injuries
All Negligent Injuries
480
However, this is still an over estimation because this assumes that all claims involve a negligent injury
176
Files a Claim
37% of Negligent Injuries Results in a Claim

15. Deaths Due To Medical Errors

16. Strategies That Can Make A Difference

17. What Makes A Leader ? Expertise Execution Emotional Intelligence
Leadership Traits
Leadership can be hard to define and it means different things to different people. In the transformational leadership model, leaders set direction and help themselves and others to do the right thing to move forward. To do this they create an inspiring vision, and then motivate and inspire others to reach that vision.
Vision
Innovation

18. Habits Of Highly Effective Leaders
Watch The Money
Monitor Quality and Performance
Spend Time Planning
Participate and Have Productive Meetings
Spend Time on Staff Development and Retention
Support Data Management Efforts
Build Networks and Relationships

19. Becoming an Effective Leader
Define and clarify roles, goals and expectations
Don’t accept denial, blaming, excuses and scapegoating
When things don’t go right, beware the “victim mindset.”
Don’t let department heads and team or project leaders off the hook
Take initiative to figure out where the barriers to success lie
Set milestones and metrics
Find balance between process and results

20. Critical Success Factors
Shared vision – leadership and organizational transformation
Accountability for learning and performance outcomes
Information for evaluation, continuous feedback and benchmarking
Commitment of resources, time, and energy

21. Leadership Structures and Systems
Leadership structures and systems must be established to ensure that there is organization-wide awareness of patient safety performance gaps,
Direct accountability of leaders for those gaps,
Adequate investment in performance improvement abilities,
Actions must be taken to ensure safe care of every patient served.

22. Leadership Structures and Systems
Do you have a patient safety program?
Is there education on patient safety and patient safety plan?
Just culture where frontline staff are comfortable disclosing errors but still maintains accountability
Is there a patient safety officer?
Who coordinates patient safety education?
With direct and regular communication with board and senior leaders?
Senior leaders and department directors are accountable to close performance gaps

23. Leadership Structures and Systems
Is there an interdisciplinary patient safety committee?
Do leaders support the committee?
Board and leaders help set patient safety goals
Oversee RCA and feedback to frontline workers
Provides training in teamwork techniques
Direct organization-wide leadership accountability
Board briefed in results of culture survey and activities to identify and mitigate risks
Every board meeting should include patient safety issues

24. A Successful Organization
The difference between a successful organization and one that is not can usually be attributed to leadership.
The individual capabilities of the people in any organizations are the same, whether in a military unit, business, volunteer organization, or anything else.

25. “ Coming together is a beginning; keeping together is a progress;
working together is success “
-Henry Ford