Creating a Culture of Safety at Georgetown University Hospital

Transparency, accountability are key

By Stephen Evans, MD

Academic medical centers and teaching hospitals across the country seek to improve patient safety. At Georgetown, we felt that our performance was adequate but not perfect, so we began a significant improvement initiative in February 2010. Two of its elements proved to be crucial: transparency and accountability.

Our intent was to establish a clear, discrete culture of patient safety. We began building our Center for Patient Safety by assembling a broad-based group that includes doctors, nurses, pharmacists, administrators, residents, and students that meets weekly and guides our efforts. We developed specialized curricula for multiple target audiences, teaching each group about its role in patient safety, core measures, care coordination, handoffs, and communication.

Next came the transparency piece. It was crucial that we undertook to learn from our past mistakes. We held Patient Safety Forums quarterly in our auditorium. In those forums, we reviewed all of our closed-claim cases from the past 10 years, presenting the information in a brutally honest fashion and soliciting input on actionable items.

To further integrate transparency, we hired a Safety Communications Director. That person helps us define our measures of success, then collects tons of data for our safety dashboard to make sure we’re on track. I think creating that dedicated role speaks to the importance we place on safety.

The second key element in our transformation was establishing accountability. Our previous incident reporting system worked pretty well. It allowed anyone to report anything, near misses and vulnerabilities, and had been generating about 4,000 reports per year.

One of the main strengths of the culture here at Georgetown University Hospital is that we are warm, kind, and fuzzy. To consider accountability options, we had some admittedly difficult conversations. However, the outcomes changed my preconceived notions about how well those options would be adopted.

We settled on a four-step process for safety violations, which can be accelerated in especially severe cases: verbal reprimand, written reprimand, suspension, and termination. The policy formally went into effect on May 1 of this year. Despite my fears otherwise, reporting actually increased, including self-reported incidents. I believe that people had a sense of security because we have tried to keep our focus on processes rather than individuals. In many of the reports, the reporters offered input on how to fix the process, or offered to help find a fix. Many issues were solved very quickly.

Academic medical centers are complex, matrixed organizations with many moving parts. Although they present a tremendous challenge, they also present a tremendous opportunity for improving patient safety and care delivery in this country; we can capitalize on change by integrating trainees into the process. They are a crucial part of the effort, and if AMCs don’t include house staff, they will fail.

We marshaled a small army of people and invested six figures in creating the Center for Patient Safety. Although it is our goal to be among the top 10 hospitals in the United States, we are not yet consistently above 95 percent on all of the core measures. However, we are very pleased to have received a patient safety award from the District of Columbia Hospital Association in October, only 18 months after we began this process. The award was a tremendous validation of all of the work everyone here has done.

–Stephen Evans, MD, is vice president for medical affairs and chief medical officer at Georgetown University Hospital , as well as a practicing surgeon. He can be reached at