Study offers recommendations for scaling patient safety initiatives

For immediate release: Monday, November 5, 2018

BOSTON – Time, flexibility and engagement are the keys to successfully implementing patient safety initiatives at scale, according to new recommendations published today for policy makers at the hospital, hospital association, state and national levels.

The recommendations emerge from a new study published in Health Affairs Monday of a large-scale surgical safety improvement program in South Carolina. Led by the South Carolina Hospital Association and Ariadne Labs in Boston, the program is a multi-year effort to implement the Surgical Safety Checklist across the state.

In a 2017 paper, researchers showed that 14 South Carolina hospitals that completed a checklist implementation program saw a 22 percent reduction in post-surgical mortality. In this paper, researchers compared two groups to understand the factors that contributed to success in implementing the checklist. In the first group are the initial 14 hospitals combined with 15 more hospitals that completed implementation by 2017. The second group includes the remaining 35 hospitals that participated, but have not completed the program.

The lessons, according to authors, are generalizable to the U.S. and add to the limited knowledge of scaling patient safety initiatives. Recommendations include:

  1. Engage all stakeholders
  • CEOS: Hospitals where the CEO participated in the implementation program were more likely to succeed. CEOs should be given opportunities and tools to stimulate action.
  • Nurses: Implementation activities were largely carried out by nurses and they were the most direct connection between the program, hospital and physicians. Preparing nurses to build physician support is critical.
  • Physicians: While there are barriers to engaging physicians in patient safety initiatives, participation by physicians resulted in significantly more successful implementation. Tailored content can help physicians to be checklist leaders who drive improvement.
  1. Offer various types of programs

Both low-touch and high-touch activities are needed for successful implementation across a variety of different sites. For instance, webinars should be supplemented with coaching calls, as needed.

Building in flexibility for adaptation within each hospital is critical.

  1. Allow time & resources

Successfully implementing the checklist in South Carolina has taken upward of eight years, and additional hospitals are continuing to join the effort. Changes to workflow, communication and culture, process and structure require a long-term commitment if they are to be sustained. Resources in the form of staff and clinician time were key to achieving widespread change.


Deborah O’Neil
Director of Communications
Ariadne Labs

Ariadne Labs is a leading health system innovation center at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health whose mission is to save lives and reduce suffering by creating scalable solutions that improve health care delivery at the most critical moments for people everywhere.