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I have had the pleasure of working with some great health system and hospital clients that have achieved national recognition for achieving meaningful and sustainable improvements in quality of care and patient safety.  These are not manufactured results for some national magazine survey or billboard campaign.  Their quality scorecards, based on national standards, are impressive.

Do you know what characteristic is evident in each of these star organizations?  A CEO with a laser-like focus who is passionate about quality and safety, a leader who is willing to stake his/her personal and professional reputation on achieving and sustaining excellence on these two deliverables, and every employee in the organization knows it.

A colleague, someone I personally admire and respect, works for a health system that is struggling with quality. The employees know it.  They all talk about it – outside of earshot of the patients, of course. He is seeking another job, determined never again to work for a CEO who does not put quality and safety ahead of all else, including his social calendar or vacation schedule. 

All this talking in my friend’s current organization has led to some amazing excuses and, sadly, inaction.  The leadership team just can’t seem to overcome their inertia on this critical subject.  Intellectually they want to do something but they cannot seem to see a clear pathway.  Their excuses run the gamut – take your pick from the usual suspects: poor leadership by the CEO; doctors who have grown complacent or more focused on financial returns than their patients; overworked nurses; the nasty, socially reprehensible financial costs associated with frivolous malpractice claims.

 We all know that there are causes for poor quality — it is not always simply the physician or a nurse — but many organizations adopt what I call “non-blame solutions.”  They spend a great deal of money on quality improvement in search of an easy answer where none exists instead of focusing on creating a culture of quality care that is real, and holds people accountable for improving the situation. 

All of this rationalization aside, I have come to believe that hospitals that suffer from continuing poor quality of care and patient safety do so because they choose to.  They could do something about the problem but they don’t.  What a damning statement, but the truth is that if you strip away all the excuses, the leaders and the physicians just cannot make the hard choices, ruffle feathers.  They say they do, because that is what people say who recognize that certain behaviors or outcomes or bad but lack the will or ability to drive change.

Sometimes it is just easier to do nothing or, worse, go through the motions – including meetings upon meetings, the engagement of consultants, the development of process improvement plans, and the investment in elaborate programs for collecting and plotting data.  The painful truth is that if the leadership team lacks the passion to fix the problem, if they are unwilling to stake their personal and career reputations on solving the situation, then most of what they say, the efforts they make, and the money they spend on equality improvement, is just the equivalent rearranging the deck chairs on the Titanic.

© 2011 John Gregory Self