Who might fill the role of your patient safety officer?

If you don’t already have a patient safety officer in your institution, it might just be a matter of time before you do. But should you be the person who fills that role? And if you’re not, how does that new position fit in with your role in the organization?

There is no doubt that the number of patient safety officers is on the increase, says Jeffrey Driver, JD, MBA, chief risk officer with Stanford (CA) University Medical Center and president of the American Society for Healthcare Risk Management (ASHRM). Health care organizations are seeing the value in having a position devoted specifically to patient safety, but there is great variety in how organizations set them up, he says.

Some mix risk management and patient safety together, while others keep them as distinct positions. Both approaches can be valid depending on the particular needs of the organization, Driver says. In a previous position at Beth Israel Medical Center Deaconess in Boston, he reorganized the risk management department to make all the risk manager patient safety officers. The change worked out well, partly because the hospital already had an integrated quality and risk department, he says. "We basically eliminated walls and barriers," Driver says. "If one of your major areas of loss is your med mal area, you want to tackle that with a patient safety program; sometimes, it is best to eliminate those barriers between that effort and risk management."

More than a fad

ASHRM recently released a monograph, "The Growing Role of the Patient Safety Officer: Implications for Risk Managers." It notes that the implications for risk managers are "huge when a leadership restructures an organization" to formalize patient safety officer responsibilities. ASHRM notes that this trend gives risk managers "an opportunity to highlight their current contributions to patient safety, develop additional skills, and expand their profile."

The monograph goes on to emphasize that the move toward patient safety officers (PSOs) is much more than just the latest fad. "Ideally, the PSO role is not merely a title change or a cosmetic change to an existing position because it is based on an emerging cultural change unlike anything that has occurred in health care," it says. "The PSO role and function should be purposefully structured to achieve the goal of a culture of safety and not as a fulfillment of some regulatory or accreditation requirement."

(Editor’s note: To download the monograph, go to the ASHRM web site at www.ashrm.org and select "Monograph" from the first page. Then find the patient safety officer monograph posted on June 4, 2004.)

Career path for some

The move toward patient safety officers can be seen as a career opportunity for risk managers, Driver says. The position can be seen as a distinct career path, or it can be a growth area within your current position, he says. Pursuing a position as a patient safety officer can present the opportunity to move beyond the traditional risk management activities, Driver suggests. "Patient safety goes beyond the general risk management concepts of loss control into broader issues like the culture of safety, specific programs to improve patient safety, nonpunitive policies, and so forth," he says. "The risk manager has tremendous growth opportunities in patient safety."

Can aid risk manager

But the patient safety officer is not always a risk manager. At Stanford, patient safety officers are distinct from the risk managers, but Driver says they should not be seen as any kind of threat to those who remain in more traditional risk management positions. "If you have a patient safety officer, you have a deputy risk manager. They’re helping you with loss control," he says. "It’s really a partnership. You probably have enough things to do so it should be nice to have someone else who can specialize in that particular area."

Patient safety officers will hold various positions in a corporate structure, Driver says, with some reporting to the risk manager and some reporting directly to the CEO. Others go through the quality department. "Reporting to the risk manager is not typical," he says. "Patient safety is being carved out as a distinct profession and often it originates more in quality than in risk management."

Not business as usual

Risk managers may in a position to support the addition of a patient safety officer to the hospital’s structure, Driver says. Administrators may question why another, separate person is necessary to address patient safety. "It’s common to wonder why we need one person we can’t afford," he says. "But if you are having a number of medical accidents, a pattern of them, or you have cultural issues that are not being addressed, the risk manager should offer support for why a patient safety officer might help."

The risk manager can help determine where the patient safety officer should fall within the organization’s structure, he notes. But what if you think this is a position you should pursue yourself? Driver says the first step is to assess your own background and skills and determine how well you fit the bill.

Remember that the patient safety officer isn’t just an updated name for risk managers, he notes. While some risk managers will be able to step right into the new position, some will find it more difficult. "Some risk managers think they have been doing patient safety for 20 years, that patient safety is the same thing as traditional risk management," Driver says. "Actually, they’ve been looking at accidents and reacting to them, maybe putting in some proactive policies. But patient safety goes far beyond that, and you have to really stay on the cutting edge."

No need to change positions

To be effective in a patient safety role, the risk manager must be willing to study the latest theories and strategies — and new ones are coming every day, Driver says. If you are more comfortable with the more traditional risk management concerns and the tried and true techniques, patient safety may not be the position for you unless you’re willing to pursue more training first.

"Plus, some risk managers realize that they are so busy with claims and other risk management concerns that they couldn’t possibly get to all those patient safety issues," he says. "That’s fine if you recognize that it’s too much to handle and you need a separate position for it. There’s no shame in saying you’re going to stick with the traditional risk management because that need will always be there no matter what happens with the patient safety officer."

Driver admits that once the idea of a patient safety officer is raised, it can be difficult for a risk manager to tell superiors that you’re not prepared to take on that role. The strategy at that point is to make a business case for why a separate patient safety officer would benefit the organization.

"It will be right for some people, but you don’t do your employer any favors by biting off more than you can chew," he says.