Advocate health care: a systemwide approach to quality and safety.
BACKGROUND: Advocate Health Care's culture of safety is rooted in its mission, values, and philosophy and demonstrates a profound regard for the welfare of those it serves. Its five values--excellence, compassion, partnership, equality, and stewardship--provide the foundation for interactions with patients. PATIENT SAFETY AS A LEADERSHIP AND ORGANIZATIONAL PRIORITY: Patient safety has been a leadership and organizational priority since 1999, when the chief executive officer and chief medical officer appointed an eight-member patient safety task force. The treatment of patient safety as a priority is reflected, for example, in sustained support for the patient safety task force's four teams (labor and delivery, nosocomial infection prevention, medication error prevention, and delayed/missed diagnoses), in the allocation of significant financial resources to technology, and in the dedication of additional capital to create safer physical-facility designs. CHALLENGES AND LESSONS LEARNED: To implement and sustain a culture of safety, Advocate addressed three challenges: complexity of the system, underreporting of patient safety events, and medical staffs acceptance of the disclosure policy. For example, strategies to address the underreporting challenge include creating a standardized patient safety event form, integrating disparate databases for patient safety event reporting, and providing ongoing education to reinforce the need to report events. Advocate's most significant area for improvement is to become less reliant on risk reduction strategies that may result only in short-term improvements.