Trickle-down economics is a policy that gets a lot of heat from certain sides of the political aisle. But apparently trickle-down leadership is a must for healthcare.
One of our program leaders made a comment about how he would not work at a program where risk management answers to the team’s legal counsel. The implication of this, was that if risk management was not reporting to the CMO or CEO, the hospital had philosophy of safety that was an anathema to a culture of patient safety.
When asked what could be done if our institutions risk management reported to the wrong agency, the answer was succinct, “find work at a different hospital.” When asked what could be done if that wasn’t an option, the quote “culture kills the best strategies” came up again.
Without support from administration and leadership, changes are improbable at worst and ephemeral at best. Practitioners in such systems are handicapped in what they can do. Scopes of change must be drastically reduced. There is certainly still work that can be done, raising awareness of patient safety issues at a minimum, but for the mental health of aspiring patient safety advocates, perhaps expectations of what can be done should be curtailed.
I recently felt betrayed because an attending of mine left the program because she disagreed with the “philosophy of the institution”, but perhaps she had a point. As a resident, committed to several more years at my institution, unfortunately that’s not an option for me.