A Story About a Hospital Putting Safety First Over Patient Satisfaction


In yesterday's blog post (“Safety is always our top priority” – From lip service to daily practice?“), I challenged hospital leaders to back up the “happy talk” with real action and stories about putting safety first. It's easier said than done.

I wanted to share a story from Karen Kiel-Rosser, Vice President/Quality Improvement Officer at Mary Greeley Medical Center in Iowa. MGMC is a KaiNexus customer, they've recently received the “Gold” level recognition in the state Baldrige process, and she's an upcoming podcast guest (to talk about Baldrige).

Below, you can find a transcript and “bonus audio” that we recorded after the main podcast. She tells a story of patient safety trumping patient satisfaction. Doing the right thing for the patient might make the patient unhappy. Their survey scores might suffer as a result (which can have a financial impact). But they seem serious about doing the right thing.

Listen to Mark and Karen (Learn more about Lean Blog Audio):

Mark Graban: …Karen, there's one other bonus question I'd like to bring up around this idea of patient safety being a top priority. I cringe sometimes.I see, and it seems in every news story about a preventable medical error, there's always a spokesperson or an executive who says the same thing. “At XYZ Health System, patient safety is always top priority and blah, blah, blah.”

The follow up question that I would always want to ask one of those executives is, “OK, tell me about a specific story, a specific instance where a decision was made that demonstrates putting patient safety above speed, flow, or efficiency, or cost, or other factors.”

I'm curious, what are your thoughts on that issue? Do you have a story about how patient safety has been really demonstrated as a top priority?

Karen Kiel-Rosser: Sure, I can share. In our organization we always say safety trumps anything. Safety trumps privacy. Safety trumps satisfaction. Safety trumps almost anything. An example I'll use is our fall risk program.We have a new fall risk program. It's about a year old. We adopted it after many years of study, looking at some best practices, and really trying to get to zero falls. Our goal is zero.

Our goal is never to have a fall. We have a no fall risk assessment. Many times, I would say 80 percent of our patients, are on a fall risk. I bet, Mark, if you or I were in a hospital, we'd be a fall risk. If you're in the hospital, you're not quite yourself, and you could probably fall, possibly.

Our patients aren't always very happy with that. It means that they're going to have a bed alarm on. It means that when they're sitting up in their chair, they're going to have a chair alarm on. They're going to have to go to the bathroom with the assistance of someone else.

That's because we are so serious about protecting our patients from harm. Sometimes our patients don't like that. They'll tell their doctor they don't want that on there, or they'll tell, when we go out on rounds, they'll tell us that they don't like to have the chair alarm on.

We explain that it's really about safety. I can sight numerous stories where we hear that from patients or we hear that from a doctor that they're unhappy with that, but truly safety in that instance trumps their satisfaction or privacy.

There are many other ways that we can satisfy and make our patients satisfied with the care, the service. We really focus on the safety piece. Like I said, we say safety trumps you name it.

Mark: I like especially the part of the story where you talk about explaining why to the patient. That follows good Lean habits whether it's with employees, or with anybody.It's not just, “Well, do this because…” It's not a matter of, “Do this because we said so,” but, “Here's the reason why,” and try to help people understand.

If somebody were responsible for HCAHPS scores on patient satisfaction and that has an impact on reimbursements sometimes. If somebody says, “Oh, the care and this is really hurting our HCAHPS scores.” Your response would be?

Karen: My response would be our fall risk rates have dropped. We don't get the results that we are getting and we can statistically show that our fall rates are dropping with this new program in place.I've had that question asked of me, “What happens when we see our patient satisfaction scores? Our engaging scores go down and that's value based purchasing.”

We know where that goes and then we take a look at our fall rates. I can honestly tell you I‘ve had that conversation with our board and they agree. That's by far more important.

Mark: That seems like a really important part of the equation that the board supports this.

Karen: Absolutely. The board is very engaged in our safety initiatives. They see our preventable harm index every month. They know the initiatives. They set up some of the goals.They're with us and help us develop those goals. They know how important that is in the industry. They know how important that is for our patients. They support us in those efforts.

Mark: That's a great example. That really does bring to life the idea of putting safety first and illustrates the importance of I'll come back again to the idea from Dr. Deming, that quality starts in the boardroom. The same applies for safety. It's great to hear about that support.Karen, thanks for bearing with me asking that one more question, and sharing such a great story.

Karen: Sure.

Does your hospital have a similar story of putting safety first? “Stopping the line” in the operating room when somebody has a concern about a potential risk — that's an example of putting safety first. What stories do you have or what would you like to see happening?

If you're an outsider to healthcare who is a patient or a family member, what's your reaction to the situations where safety is NOT a top priority? Please post a comment.

What do you think? Please scroll down (or click) to post a comment. Or please share the post with your thoughts on LinkedIn – and follow me or connect with me there.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. One thing I find annoying is when people talk about patient “choice” as if that is the fundamental principle in health care. We often try to simplify things so much that they are untrue. Health care is complex and trying to point to pithy sayings does more harm than good I think.

    Patient focus matters but there are conflicts between what is the best care and what patients want. And there are conflicts between what those paying for care want and drug companies want and hospitals want and doctors want. These require difficult choices and in order to optimize results we need very well designed systems that take these issues into account.

    Sadly I think the USA generally has very bad systems in place. The rest of the world isn’t that great either, but by and large is better than the USA and MUCH cheaper. Most health care providers care about patient care and often make heroic efforts to provide it. But the systems are just lousy.

    Those systems that seem the most lousy to me around extracting cash from payers – it is absolutely horrible in so many ways in the USA. Sadly this creates HUGE waste in the USA that is ripe for improvement (and has been for at least 30 years). Patient care also has plenty of room for improvement, but thankfully it isn’t as messed up as the whole payment system is.

    We need to have systems that are patient focused but that doesn’t mean patients dictate treatment.

    • Costs would be a lot lower in the US (and lower in other countries) if patient safety was truly the top priority.

      If we look at the performance of “top hospitals,” the risk of injury and death is lower.


      From 2011-2013, if all hospitals, as a group, performed similarly to hospitals achieving Healthgrades 2015 America’s 100 Best Hospitals Award, 172,626 lives could potentially have been saved. For patients treated in hospitals achieving Healthgrades 2015 America’s 100 Best Hospitals Award, there is roughly a 26.4% lower risk of dying than if the patients were treated in hospitals that did not receive this recognition, as measured across 19 rated conditions and procedures where mortality is the outcome.

      And studies show that high quality care actually correlates with LOWER cost.


  2. Also from Linkedin:

    Mike Crompton:

    I was fortunate to work in the Chemical industry early in my career. The Safety, Health and Environmental culture was the leading priority for all business activities – confirmed on the CEO’s visits, rigorously supported by management – and the company culture. The key mantra was “Nothing is so important that we can’t take the time to do it safely”. Relating back to this article, and each subsequent role I have held; I find that if you consider any safety issue in that light, it is an ideal prompt to Prioritise appropriately – clarifying what you Should do, and what you shouldn’t! The injury you prevent may be your own…

  3. This is a great post! There are many ways of increasing patient satisfaction without compromising safety. A pleasant smile, introducing yourself and what you do, and listening carefully to a patient’s question or concern are a few ways. Most people will be more forgiving of safety rules when they feel that they are cared about and listened to.


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