Case Study Question:

1. Increasing the Focus on Patient Safety at First Medical Center case: Why might the transformational leadership approach be appropriate for Dr. Frame to use? Using information from this chapter and the case study, describe specific steps and actions she should take while using transformational leadership.

Case: InCreasing the Focus on Patient Safety at First MediCAL CENTER At First Medical Center (FMC), the goal for the past decade has been to simultaneously improve quality and patient safety by implementing projects, initiatives, and programs either focused on an organizationwide intervention or targeted at one department, unit, or floor within the organization. This effort has resulted in a piecemeal approach to quality improvement, with one intervention layered on top of another. FMC's newly appointed chief quality and patient safety officer, Dr. Emily Frame, believes they can do better. Emily sees a major opportunity to centralize and standardize quality initiatives through a systemwide initiative focused on both cultural change and quality improvement. Specifically, she wants to implement the Crew Resource Management (CRM) program across all units of FMC. CRM is a systematic approach to training leadership, staff, and physicians, and it incorporates customizable safety tools aimed at generating permanent culture change around patient safety. Emily is aware that adopting a unified approach to safety and quality improvement will require significant organizational change, but she believes the long-term results will justify the expected difficulty. Given the circumstances at FMC, Emily believes that the first challenge will be to get the leaders of the institution to understand that a gap exists in patient safety and to recognize the opportunity for improvement. She is well aware that cultural transformation needs engaged leadership, and she knows that only through shared vision and purpose can such widespread programs succeed. If leaders are not engaged and supportive, the program will struggle to get off the ground, making the desired transformation virtually impossible. Another major challenge related to executive leadership buy-in involves the financial resources necessary for implementation. Healthcare organizations have a large number of competing financial priorities, not the least of which are training and education. Training for CRM requires dedicated time away from patient care (between two and four hours), so the organization will have to backfill that nursing and physician care time. Once put into practice, however, CRM has the potential to save money by averting patient safety events. The research literature provides some evidence for these savings, particularly in critical care and surgery specialties, though systemwide implementation has never been studied. CRM has to be seen as value added and a top priority for the organization and the care of its patients. An additional area of concern for Emily involves how she will be able to measure success. If CRM aims to improve teamwork and promote a culture of safery, how can one prove that it works? What metrics would FMC leaders, providers, and patients regard as indicators of success? As Emily well knows, cultural transformation is hard enough to define, let alone measure