Becker's Clinical Quality & Infection Control

15 PATIENT & CAREGIVER EXPERIENCE Safety and on-site hospital leadership: A complex balance By Kelly Gooch T he COVID-19 pandemic forced healthcare organizations to think differently about the workplace. Hospital and health system employees, particularly certain non-clinical staff, started working remotely when the crisis struck. ese days, hospital and health system leaders are still learning how to embrace on-site and work-from-home approaches amid evidence that hybrid work is here to stay. A report from McKinsey Global Institute, released in July, found that office attendance was stabilizing at 30 percent below pre-pandemic norms. It also found that workers in healthcare tend to go to the office 3.4 days per week, on average. It is unclear how many hospital leaders themselves work under a hybrid work arrangement due to limited data, although there are job postings on LinkedIn that indicate some opportunities for certain leadership positions outside of the C-suite. Within the C-suite, many CEOs of Fortune 500 companies have made an office comeback. In healthcare specifically, Becker's has reported at least one system where the C-suite never went remote. e nature of healthcare work also raises questions around how or if leaders' on-site presence affects safety: Does engaging with clinicians correlate to better patient outcomes? A hospital CEO in Philadelphia recently updated his on-site schedule aer state officials identified safety lapses at the facility, but the lack of hard data means the question remains open. Ultimately, there is no one-size-fits-all approach to work models for hospital leaders, and leaders must work in a way specific to their organization's needs, resources, structure and priorities. But for leaders at all healthcare organizations, no matter their schedule, it is important to build relationships, establish trust with the workforce and stay visible to staff and to patients and families, according to Jeff Salvon-Harman, MD, vice president of safety at the Institute for Healthcare Improvement. "ere's an accessibility element of being a healthcare leader that can't be understated," Dr. Salvon-Harman told Becker's. "How that gets managed is much more individual." Dr. Salvon-Harman joined IHI in September 2022 aer serving as chief patient safety officer and vice president of the Quality Institute at Albuquerque, N.M.-based Presbyterian Healthcare Services. He provided an expert lens on the safety side and pros and cons of top leaders being on-site. ree pros and cons, according to Dr. Salvon-Harman: Actively engaging with front-line workers on safety, without neglecting other duties "e ability to influence culture as a leader when you're not physically present, as well as the opportunity to have direct eyes on operations and the conduct of the workforce and directly observe the practices that engender safe care, are significantly curtailed when you're not physically present," Dr. Salvon-Harman said. But he acknowledged CEOs have many responsibilities and cannot be present in patient care spaces all of the time. "It is a balance, but the pro of being physically present in those clinical spaces is that direct interaction," he said. "Patients or the workforce can approach hospital leaders in clinical spaces and express any concerns around safety practices." How a CEO's presence affects the workforce, positively and negatively Dr. Salvon-Harman said workers may not feel comfortable approaching and voicing their concerns about a current procedure or care that's being given in front of the CEO. He acknowledged this also depends on the organization's specific leadership, climate and culture of safety and whether that's being actively supported by the leader. But a CEO's presence can also have a positive impact, Dr. Salvon- Harman said. "In organizations with a strong safety culture and authentic leadership based on trust, respect and dignity, the impact of leaders rounding in person can be profoundly positive. Approachability, active listening, action to address voiced concerns, and follow-up with the workforce member to close the communication loop are ideal leader behaviors that in-person contact optimizes through personal relationships and accountability." Potential misunderstanding of care practices, or a fresh perspective "If you are a hospital leader who doesn't have a clinical background, for example, or if your clinical background is in a different discipline, you may see things that you don't recognize as a safety concern, or you might see something and perceive it as a safety concern [when it] is a standard operating procedure that you're not familiar with," Dr. Salvon-Harman said. He added that this can result in disruptions of workflow, misdirection of workforce members, interruptions or distraction. On the other hand, "there are times that a fresh set of eyes can see a risk or danger that has become otherwise normalized by those close to the work, which can lead to effectively mitigating that risk and benefiting patients and the organization," said Dr. Salvon-Harman. "Ultimately, such interactions are hindered by remote contact, in which a full view of the care setting, interactions with the workforce and patients, and authentic relationship building are marginalized in comparison to in- person rounding." n "e ability to influence culture as a leader when you're not physically present, as well as the opportunity to have direct eyes on operations and the conduct of the workforce and directly observe the practices that engender safe care, are significantly curtailed when you're not physically present." — Jeff Salvon-Harman, MD

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