Define expectations to see improvements

Saying you put patient safety first is good, but you won't see any results until you specify what behaviors you expect to see, says Ann Rhoades, former chief people officer for Southwest Airlines and Doubletree Hotels, and one of the five founding executives of JetBlue Airways. She is also the president of People Ink, in Albuquerque, NM, a culture-change consulting firm that works with hospitals and other employers.

Health care providers must clearly define what behaviors they expect of physicians and staff, she says. "The behaviors are so critical. Every hospital puts values on the wall, but most of them don't define behaviors related to those values," she says. "Once they start defining those behaviors -- telling people that you expect them to speak up and tell the truth even when it's hard -- that's when you actually see those values take hold and make a change."

Rhoades recently worked with Loma Linda (CA) University Medical Center to encourage a culture of safety. Hospital leaders had been working for about a year and a half to encourage physicians and staff to speak up. A key part of that effort, in addition to the common efforts at education, has been the commitment by top leadership, Rhoades says. The hospital CEO committed the entire organization to not only hearing the concerns of physicians and staff regarding patient safety, but rewarding them and recognizing them for their effort, she says. Chief nursing officers emphasize to new employees that the hospital expects them to voice their concerns, and physician leaders make clear that doctors are expected to listen respectfully to staff concerns.

All Loma Linda caregivers are assessed on their annual reviews for their behavior regarding patient safety and speaking up, and the accountability is carried all the way up to the executive level, Rhoades says. Holding people accountable for their behavior is key, rather than just making them aware of the hospital's philosophy toward safety, she says.

At another hospital Rhoades worked with, a cardiologist was berating people when they spoke up, acting directly in contrast to the effort to the culture of safety the organization was trying to instill. "He was a very well-known practitioner with great skills, but not someone who encouraged safety and quality. They did not renew his privileges, and it cost them a lot of money because their operating room time was down for a while," she says. "But then nurses wanted to work in that area again, and they knew it was the right decision. Great leaders have to make that kind of decision sometimes."


• Ann Rhoades, President, People Ink, Albuquerque, NM. Telephone: (505) 822-7934. E-mail: