Building and sustaining a systemwide culture of safety.

BACKGROUND: In 2002, Sentara launched a systemwide initiative to significantly reduce events of harm to patients and employees. The initiative began at Sentara Norfolk General Hospital. Since then, the safety principles piloted there have been instituted throughout Sentara's integrated health care system of hospitals, nursing homes, and physician practices. ACCELERATING THE PACE OF IMPROVEMENT: Implementation at each local site begins with a thorough assessment of its safety culture. Four core areas of focus include (1) establishing safety as a core value, (2) creating Behavior-Based Expectations (BBEs) for error prevention that are tailored for staff, leaders, and physicians, (3) developing a state-of-the-art root and common-cause analysis program, and (4) implementing an approach to focus and simplify work processes and procedure documentation. KEYS TO SUCCESS: Senior leadership demonstrated a commitment to making safety a core value by embedding safety into strategic priorities, incentives, rewards and recognition, and human resources policies and procedures; prioritization of operational goals to ensure the availability of time and resources to make the safety initiative the key focus; involvement of employees and medical staff each step of the way; establishment of site-based safety initiative teams of operational leaders with the responsibility for leading the safety initiative implementation and ensuring effective communication across the organization; and a willingness to learn and try successful techniques from high-reliability organizations outside health care.