Prioritizing Safety Remains Job No. 1

The path to preventable zero patient harm is key to the success, safety of our workforce.


The agendas of leaders today are complex and crowded. While taking care of patients remains the primary focus, the industry continues to navigate an evolving set of workforce and financial challenges and impacts. At the intersection of these challenges lies an enormous opportunity to relaunch our safety efforts. It is uniquely suited to be the link between data and innovation, while propelling us forward to redesign care and support our patients and workforce in new ways. This one true north remains central for all of us—compelling us to do our best for the patients who put their trust in us.

It is also evident that with applied focus and effort, positive outcomes can be achieved. Take, for example, the July 2022 study published in the Journal of the American Medical Association, noting that in-hospital adverse events decreased between 18% and 41% from 2010–2019. 

Much has happened since 2019, and we emerge knowing that our ability to hardwire lessons learned, while also closing any of the cracks that have widened in our foundation, is now central to success. In doing so, the work of safety may provide the spark that reignites, reenergizes and refuels us as caregivers and care providers, as few issues are at the heart of our work than caring for others.

A great deal has been written about safety. In 2016, ACHE partnered with the Institute for Healthcare Improvement’s Lucian Leape Institute to collaborate with some of the most progressive healthcare organizations and globally renowned experts in leadership, safety and culture. Through this work, we developed Leading a Culture of Safety: A Blueprint for Success, an evidence-based, practical resource published in 2017 to assist healthcare leaders in creating a culture of safety. In addition, Safer Together: A National Action Plan to Advance Patient Safety, developed by ACHE and members of the National Steering Committee for Patient Safety, is the work of 27 influential federal agencies, safety organizations and experts, and patient and family advocates brought together by the Institute for Healthcare Improvement. Most recently, the ACHE Board of Governors updated ACHE’s policy guidance for leaders, “The Healthcare Executive’s Role in Ensuring Quality and Patient Safety.” The impact of leaders is widely noted throughout these resources.

Though patient and workforce safety require enterprise wide systematic effort, three areas seem particularly relevant for leaders today.

Leadership fundamentals matter. Though safety is not a new topic, its connection to current challenges may not be so obvious and could be a useful platform. Here the vigilance of boards and leadership teams in executing a compelling vison for safety is as important today as ever. Safety governance is a foundational practice and includes the breadth of leadership activities from strategy to operational oversight and should include ongoing board education. Leadership development practices can cover core and evolving skill sets, while also providing powerful opportunities to develop key champions and strengthen collaborative problem-solving between clinical and nonclinical leaders. By measuring progress, identifying gaps in progress and learning new approaches, leaders can create sustainably safe environments and drive positive results for patients, families and the workforce.  

Building trust, respect and inclusion are essential. The everyday actions of leaders, and the behavioral standards and expectations applied across the organization, could be the most defining aspect of culture. Leaders establish the culture they value, and those norms and beliefs become the climate for all. Safety and equity are best achieved in environments that build respect, trust and inclusion through ongoing education and training, collaboration and transparency. Trust, respect and inclusion must be nonnegotiable standards that consistently apply to all, from the board room to the entire workforce. 

Trust, respect and inclusive practices are also fundamental to improving outcomes for patients by building a diverse workforce capable of delivering culturally competent care and working to eliminate disparities. 

The words and actions of leaders are the secret sauce that can glue or divide an organization and the impact it will achieve for its communities.  

Developing the workforce is a must. An essential component of patient safety is the physical and psychological safety of the workforce. Supportive and healthy work environments are characterized by continuous learning, ongoing support, professional growth, teamwork and transparency. Policy and practice must go hand in hand. Organizations that invest in the workforce note the benefits of helping care providers reconnect with the meaning of their work, while driving higher engagement, satisfaction and reducing the likelihood of burnout. Finding new and creative ways to support every person in the continuum of care helps to deliver more effective and safer care for all.

Providing safe patient care is our primary mission as healthcare leaders, and at the core of that mission is the safety of patients, families and our workforce. By reinvigorating our focus, we can identify new ways to use safety principles and tools to make meaningful strides on our journey toward the ultimate goal of preventable zero patient harm for all.

Deborah J. Bowen, FACHE, CAE, is president/CEO of the American College of Healthcare Executives (