How to create change when you are not in a position of leadership

Since the Institute of Medicine’s 1999 report, To Err Is Human, both the public and healthcare professionals have focused on patient safety. But the question that consistently comes up is how healthcare professionals can help create positive patient safety change when they are not in a position of leadership. To answer that question, we went to three leaders in healthcare for their advice.  Here’s what they had to say:

David Mayer, MD

Vice President, Quality, and Safety, MedStar Health

  1. Set up time with leadership preferably (1) their CEO if possible to discuss the hospitals and Board’s commitment to QS and (2) their CMO or Chief QS Officer/Director to discuss the activities currently going on in QS. This will give them an idea of the commitment as well as specific projects going on they could get involved in (or suggest something new that aligns with their interest). Much better to have alignment with leadership as this will get you support/help break down barriers for the work you want to do.
  2. Chose a small quality improvement/risk reduction project first – don’t try to change big things by yourself. That can be difficult. This pilot project could be something specific to the clinical unit they work in. Build momentum by finding a colleague who is interested in the project to help you (we call this the first follower) do the work but more importantly to show another person’s support for the project. Once you show some success in that unit, find someone in another unit who could help move that pilot project to another area in the hospital and show the QS work is transferable to other areas of the hospital.

Robin Betts, MBA-HM, RN, CPHQ

Vice President, Quality, Clinical Effectiveness & Regulatory Services, Kaiser Foundation Health Plan & Hospitals, Northern California

We can only improve if we are aware of our problems. Any organization who cares about elevating safety wants to hear from their frontline. They are closest to the work and generally know best how to find and fix their problems. I would suggest to this individual that they use a simple communication format called SBAR. Start with the “Situation.” Give a high-level statement about the problem or risk they know exists. Then provide a little “Background” about the problem. How did they identify the problem? Next, provide a summary of their own “Assessment” of the circumstances about the event. What do they know about the prevalence of the problem? Finally, make a “Recommendation” or a “Request.” This part is where you commit to get involved. You could recommend some solutions or ideas that you think might work based on your expertise on the front lines. You could also say, “I’d like to be a part of the solution and join an improvement team that would conduct a deeper dive and come up with solutions that really work.”  Great leaders will never turn down a passionate volunteer!


Tami Minnier

Chief Quality Officer, UPMC

My advice is to absolutely respectfully approach leadership. The best way to get executives attention based on my experience is to tell real stories of patients affected by the safety events. These stories put a face and name on the concerns. In addition, share the personal pain and anguish the caregiver team experienced and how it has made them feel about their job and career. Almost all executives in healthcare got into the field because they care. Connect with that caring and ask for their help. Ask them to listen. Ask them to get involved. Ask them if it would be ok to call them the next time an event occurred for their help. This simple approach has been very successful through the years for me.