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Leadership qualities for a patient-safety turnaround

In recent years, Parkland Memorial Hospital in Dallas, Texas has faced intense media scrutiny and government investigations into patient safety lapses. As the hospital searches for a new CEO, the Dallas Morning News asked me and other experts to answer the question: "What kind of leader does Parkland need to emerge as a stronger public hospital?" Below is the column, re-used with the newspaper’s permission. While it is focused on one hospital, the themes apply broadly. The type of leader that I describe is needed throughout health care.

Parkland rebuilding ‘at the speed of trust’

Public hospitals such as Parkland are a public trust, serving the community's health needs by providing safe and effective care to a population that lacks alternatives.

Major shortcomings in the quality of care provided at Parkland have eroded that trust. Now trust must be restored. The community is counting on it. It's literally a matter of life and death.

Parkland's board is searching for a new CEO to lead this journey. The CEO's task will not be easy: Resources are tight, resident supervision is insufficient, staff morale is low, systems need updating, and preventable harm is far too common.

History may provide some guidance. Historian Rufus Fears notes that great leaders - leaders who changed the world - have four attributes: a bedrock of values, a clear moral compass, a compelling vision and the ability to inspire others to make the vision happen. Parkland needs one of these great leaders.

The key values of the next CEO should be humility, courage and love -- and these values must guide the leader's behavior. Parkland will not be able to improve unless it acknowledges its shortcomings; this will take humility. Yet Parkland is a great organization with a rich past and bright future. The leader must honor the past and look forward. The leader must be able to live with the paradox of being humble yet confident.

The leader will need courage. Author C.S. Lewis once said that "courage is not simply one of the virtues but the form of every virtue at the testing point." The Parkland CEO will be at the testing point many times every day. The leader must be unwavering in the goal to improve care yet humble enough to invite all staff to come together to realize the goal. The leader will need to make tough decisions about where to deploy scarce resources, always keeping patients as the North Star.

To avoid a revolt and get staff passionate about the vision, the leader will need to transparently communicate where Parkland is going and why, how Parkland makes decisions and what those decisions are. Yet the next CEO will need to deftly dance between democracy and autocracy, between conversations and results. To make all the needed fixes, to bring Parkland back to where it needs to be, much needs to be done, and only with a passionate and engaged staff can real change happen.

Yet perhaps the greatest value will be love. Avedis Donabedian, one of the fathers of quality improvement, was interviewed on his death bed by a student. The student asked, "Now that you have been a patient and devoted your life to improving care, what is the secret of improving quality?" Donabedian told him, "The secret of quality is love. If you love your God, if you love yourself, if you love your patients, you can work backwards to change the system."

This is what Parkland needs. The hospital's doctors, nurses and administrators care deeply about patients; they do not want to harm them. They work with broken, underresourced systems. The next CEO must recognize this and seek to understand rather than judge, to learn and improve rather than blame and shame.

This won't be easy. The public wants accountability. Parkland is under scrutiny from federal and state regulators. Yet real improvements will come from internal rather than external motivation.

The CEO will need to help the staff see shortcomings in safety as their problem and believe they are capable of solving it. The CEO will need to inspire with lofty oratory, and then drop down, roll up her sleeves, and get things done.

Parkland's next CEO needs to tap the immense wisdom within the staff by soliciting broad input and inviting hospitalwide brainstorming. The title of CEO still allows the new leader to convene meetings. But true authority comes from trust. Change of this magnitude only progresses at the speed of trust, and trust is based on being perceived as caring and competent. Both are essential. Only through caring and competence can Parkland win back the faith of the community it serves.



Peter Pronovost

One of the world’s leading authorities on patient safety, Peter Pronovost served a the director of the Armstrong Institute, as well as senior vice president for patient safety and quality, at Johns Hopkins Medicine from 2011 until January 2018.

6 thoughts on “Leadership qualities for a patient-safety turnaround”

  1. Peter Pronovost captures the absolute essence of successful leaders...this post should be re-read and sent on by all who read it. After 30 years of watching great successes and great failures in quality and safety improvement efforts, a clear picture emerges: safe care and great care exists at the intersection of leadership, practices, and technology. However, it begins with leadership, ends with leadership, is all about leadership. Healing moments occur where a love shaped vacum is filled between caregivers and patients and between ourselves as caregivers. If we want to be true healers in a healing organization, we have to embrace the soft side. It takes courage to focus our attention there. Bravo Peter!

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