Virginia Commonwealth University

Culture shift sets the bar sky-high for patient safety

Safety First, Every Day

In 2013, VCU Medical Center marked five years since “Safety First, Every Day” began, bolstering the medical center’s mission to become America’s safest health system with the goal of zero events of preventable harm to patients, team members and visitors.

“We’re doing this because it’s the right thing to do for our patients, visitors, staff and all who enter our facilities,” said John Duval, CEO of MCV Hospitals. “We are not content to be simply better than average in safety. We want to achieve the very highest standards every minute of every day.”

L. Dale Harvey, M.S., R.N., director of the Department of Performance Improvement, and her team implemented “Safety First, Every Day.”

“We decided that as an academic medical center we could not only set a new standard of excellence for safety and quality, but we could lead the nation in terms of teaching the next generation of health care professionals the behaviors and work processes that are necessary for safety,” she said.

John F. Duval

“We are not content to be simply better than average in safety. We want to achieve the very highest standards every minute of every day.”

– John F. Duval

By investigating how high-reliability industries such as nuclear power and aviation manage their safety systems, the medical center adopted the science of safety to ensure that it advances a culture of high-reliability health care.

“The leaders and team members of those organizations are constantly looking at how they can do things better,” Harvey said. “That’s the culture that we’ve created here. We’re taking a critical eye to how we do things with staff questioning, ‘Is this the best way?’ and leaders supporting the change.”

Since the inception of “Safety First, Every Day,” more than 12,000 staff members have been trained in safe behaviors and error-prevention tools. The Safety Coach program has also expanded to 150 coaches, who provide real-time feedback and support to staff on the use of safe behaviors and tools. Coaches provide assistance in more than 60 areas of the medical center and the program has expanded to the Children’s Hospital of Richmond at VCU as well.

“We have learned so much about the critical role of teamwork, escalation and effective communication, as well as the importance of good process redesign and leveraging our considerable investments in information technology,” said Ron Clark, M.D., chief medical officer of VCU Medical Center. “Each phase of the journey leads us to a new understanding of what is achievable and that ‘zero events of preventable harm’ is not just an ideal but something we can attain if we sustain our efforts.”

As of 2013, the medical center has recognized more than 150 Safety Stars and will go on celebrating outstanding staff members who put safety first and prevent harm from reaching patients.

The message’s reach continues to spread successfully as people from all areas of the medical center become more actively involved in safety and quality improvement work. The medical center recognized its first medical student as a Safety Star, and recipients of the award have also included pharmacy students, residents and attending physicians.

“Our journey to high reliability will never end. There will always be new opportunity to improve our existing systems and innovate new systems and processes to make the services we provide safer,” Duval said. “The people of the medical center will lead the way in improving the quality and safety of medical care for our patients and the commonwealth.”

Graph for eighty six precent reduction in health care-associated infections in ICUs since two thousand and three



Hand hygiene



Reduction in serious
safety event rate