Exemplar HealthNet

This hypothetical case history of a fictitious healthcare organization is a heuristic device to illustrate the execution of a planned change in safety climate and organizational culture and to demonstrate some of the ways leaders can systematically use the tools presented here to improve both patient and employee safety. This sketch draws on BST s experience with numerous interventions in a variety of settings, including healthcare. 

Exemplar s safety process was kicked off at a retreat attended by key leaders from among the trustees, corporate executives, and managers of the 10 facilities. At the retreat, leaders learned the 

11 Exemplar HealthNet is a fictitious name and has no relationship to any of the thousands of 

The leaders formulated the following vision statement for safety  

Case history—Step 3 Analyze the current state 

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FIGURE 9-1. LDI SCORES FOR EXEMPLAR HEALTHNET (A FICTIONAL HEALTHCARE SYSTEM). 

The Exemplar HealthNet interviews, focus groups, OCDI, LDI, and adverse event data all suggested that significant exposure for both employee and patient safety prevailed in the working interface. Employee safety accounted for significant costs. 

The phase I gap analysis at Exemplar HealthNet revealed that physician engagement in patient safety was at best passive and reactive. Since successful comprehensive culture change in healthcare requires physician leadership and participation, physician engagement became a formal part of the intervention plan. Physicians— whether they know it or not, and regardless of whether they want the role—are organizational leaders and culture shapers in the healthcare delivery industry. The culture of healthcare is largely authority-based, and physicians remain the leading authorities. 

This part of the Exemplar HealthNet intervention included the appointment of physician mentors to help peers adopt best practices, to develop and share ideas for practice quality improvement, and to provide positive coaching for poorer performing physicians (those who were disruptive or abusive or under disciplinary review). ... 

Why is safety an ethical imperative, a core value, and a strategic priority at Exemplar HealthNet ... 

The Exemplar HealthNet safety plan calls for readministering the OCDI in six months and then, depending on the results, annually thereafter. This aspect of the plan will provide a measure of progress, supply an important complement for a safety early warning system, and give leaders and trustees the information they need to monitor and manage the tone at the top. 

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