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Joint Commission Alert: Effective Leadership Critical to Preventing Medical Errors
Date:8/27/2009

Leaders must take responsibility for patient safety

OAKBROOK TERRACE, Ill., Aug. 27 /PRNewswire-USNewswire/ -- A new Joint Commission Sentinel Event Alert issued today urges health care leaders to step up efforts to prevent errors by taking the zero-defect approach used in other high-risk industries such as aviation and nuclear energy. The Joint Commission is advocating greater involvement of health care trustees, executives, and physician leaders, contending that the overall safety and effectiveness of a health care facility depends on administrative and clinical leaders who set the tone, create the culture and drive improvements. In safe organizations, safety is rooted in the culture and the system, rather than in the behavior of individuals.

"Health care leaders are directly responsible for establishing a culture of safety," says Mark R. Chassin, M.D., M.P.P., M.P.H., president, The Joint Commission. "This Alert provides leaders with concrete strategies for demonstrating a commitment to safety and to improving patient outcomes."

To improve patient safety, The Joint Commission's Sentinel Event Alert recommends that the governing body, chief executive officer, senior managers and medical staff leaders at health care organizations take a series of 14 specific steps, including the following:

  • Define and establish an organization-wide safety culture that includes a code of conduct for all employees.
  • Institute an organization-wide policy of transparency that sheds light on all adverse events and patient safety issues.
  • Make the organization's overall safety performance a key, measurable part of the evaluation of the CEO and all leadership.
  • Ensure that caregivers involved in adverse events that result in unintentional patient harm receive attention that is just, respectful, compassion
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SOURCE The Joint Commission
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