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MD, managing partner of Surgical Directions, a Chicago-based national consulting firm that assists providers with improvements in perioperative and anesthesia services. In particular, he cites improved efficiency, lower costs, reduced adverse events, improved stake- holder satisfaction, heightened organi- zational harmony and improvements in patient satisfaction and the facility’s rep- utation. “As complication rates are pub- lished and readily available,” he says, “patients will choose facilities that grade superior, which will benefit ASCs.”

Establishing the Culture Implementing a Culture of Safety

It begins with an environment where staff feel free to speak out without the fear of retribution BY ROBERT KURTZ


hen an ASC is working to establish a culture of safety, the focus needs to be on creating an environment where staff feel free to discuss patient safety issues and errors without the fear of retribution or blame, advises Tom Mitros, MD, an anesthesiologist and co-administrator of Specialty Surgical Center in Sparta, New Jersey. “You are trying to create a culture of psychological safety, transparency and fairness through the entire institution,” he says. “It is about always making sure the patient is the number one priority, and the number one concern is the care they receive,” says Ann Shimek, RN, CASC, senior vice president of clinical opera- tions for United Surgical Partners Inter- national (USPI), an owner, operator and developer of ASCs and short-stay sur-

20 ASC FOCUS JUNE/JULY 2014 Get Involved

ASCA is partnering with the Health Research and Educational Trust (HRET—an affiliate of the American Hospital Association), the ASC Quality Collaboration, the Harvard School of Public Health and others in a program designed to strengthen the culture of safety in the outpatient surgical set- ting, including ASCs. To learn more or get involved, please contact Kelly Vrablic at or visit

gical hospitals based in Addison, Texas. “To do this, you need an environment where there is no fear of retribution when you do speak out.” Facilities that successfully implement a culture of safety and improve quality reap many benefits, says Tom Blasco,

Before embarking on the process of establishing a culture of safety, it is essential to secure high-level sup- port and commitment to the project, says Robert Dahl, senior vice presi- dent and chief operating officer of Sur- gical Directions. “This should include a board of directors-level sponsorship and oversight of the implementation,” he says. “Leadership drives culture. It is essential for the board to empower the frontline management team, work- ing directly with staff, to implement this transformation. Without strong sponsorship and leadership, breaking down silos that exist between depart- ments and positions, implementation of a culture of safety is very difficult.” Operating under that level of sup-

port, Mitros says, his ASC sent him and his co-administrator to the Johns Hopkins Medicine’s Armstrong Insti- tute for Patient Safety and Quality last year to participate in a patient safety certification course. “After we completed the certifica- tion course, we reached out to some of the staff at the Armstrong Institute for further guidance and training to help set a culture of safety environment here at our ASC,” he recalls. “We instituted what is called the comprehensive unit- based safety program (CUSP), which, along with establishing an atmosphere of safety, transparency and fairness, gets

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