Patient safety must be ‘a strategic priority’

Hospital leaders must make patient safety part of the culture throughout the organization.

Garrett Blair, vice president of quality improvement at Sentara Health, says that’s been a big element in the health system’s progress in patient safety.

“Patient safety and quality has been and will be a strategic priority for Sentara,” Blair says. “That's consistently reinforced by our leadership group.”

Sentara has reduced hospital-acquired infections substantially, with Blair saying infection rates were twice as high 10 years ago. Eight of Sentara’s 12 hospitals have received “A” grades on The Leapfrog Group’s hospitals safety reports, and five hospitals received the 2026 Healthgrades Patient Safety Excellence Award.

Blair says meetings regularly begin with stories about patient safety.

“We drive a lot of our meetings by starting with these stories,” he says. “When a story comes up, it's used as a unique opportunity and lens to see where we have room to improve. That becomes a positive thing — we've identified this as a catch, and we can fix it moving forward. It's that lens of always trying to improve, always learning more about ourselves, that keeps it a positive process.”

In a conversation with Chief Healthcare Executive®, Blair talks about the importance of organizational commitment, measuring safety and quality, and empowering staff to speak up and raise concerns.

• Read more: Sentara Health embraces virtual nursing and AI

Standards across all hospitals

While healthcare organizations measure hundreds of different areas, Sentara has been focusing on key areas in patient safety.

“We've worked to really identify the safety and quality measures that matter most to our patients and communities, and to align our resources and priorities around those specific metrics,” he says. “I think that combination — the culture, our performance-improvement rigor, and our organizational focus — has been a powerful enabler of our success.”

Health systems shouldn’t simply delegate patient safety to leaders focused on quality and safety, Blair says.

“We've really embraced systemic approaches to performance improvement,” Blair says. “We don't view quality and safety as a collection of independent, disparate projects.

We have standard improvement methodologies, a consistent form of governance, and we set consistent performance expectations for all of our hospitals. We hold accountability to those expectations to really drive the organization toward greater performance,” he says.

Blair says culture and safety show up in the organization’s priorities, including everything from meetings to how resources are allocated. Staff pay attention to the areas leaders pay attention to, he says.

“For us at Sentara, patient safety and quality aren't side conversations,” he says. “They're part of our governance structure, part of our leadership evaluation and performance review discussions, and embedded into our improvement efforts. We resource and take quality and safety seriously, and you can see that in how we set our priorities year to year.”

Sentara also works with hospitals based on their own demographics and resources.

“There's obviously some accountability around performance to evidence-based best practice, but there's also some latitude for those sites to say this is how we need to make this work for ourselves,” Blair says.

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Empowering staff

Sentara has also worked to create a “just culture” environment, enabling staff at all levels of the organization to speak up if they see an issue that could affect patient safety.

“We've empowered team members to speak up when they have concerns, so they have a safe space to see something and say something,” Blair says.

“We've paired that with transparent data and clear performance expectations and accountability that go along with our system-wide expectations,’ he explains. “When people see leaders consistently prioritizing safety — not just delegating it to the quality department or safety liaisons in the facilities — they realize it's everyone's responsibility, and that permeates the entire culture.”

Blair says it’s important for staff to know they can raise issues without fear of reprisals, and he also stresses that it’s important to address concerns in a constructive manner.

“We're not being punitive when people bring things to our attention,” he says. “We take it to the next step and ask: is this a systems issue? We focus on being hard on the process, not the people. That's important for making sure we're being good stewards of those messages when they're brought forward. How you react when things are raised is really important. Making sure we're analyzing systems and not casting blame on individuals is one piece.”

Pick the right battles

Hospitals looking to improve on patient safety need to focus, Blair says.

And he says that’s not easy, as health systems deal with new initiatives, new regulatory requirements, and are incorporating AI and other digital tools.

But hospitals need to select the top priorities.

“Organizations should identify a manageable number of safety and quality objectives and then execute on those,” Blair says.

Years ago, Sentara focused heavily on hospital-acquired infections and patient experience scores. And he says good execution in those areas can lead to better performance in a host of areas.

Blair also focuses on accountability, in terms of data transparency and a regular cadence of performance reviews. But he also adds that it’s not about being punitive.

“I'm a big believer that what gets measured gets improved,” he says. “When people clearly understand the metric and the goal, understand their role in achieving the goal, and can see the data on a regular basis, improvement tends to follow.”

But Blair repeatedly circles back to setting some clear goals in safety and in picking the right battles. He says that’s useful advice for all health systems, including those with limited resources.

Blair sees value in executing on even a smaller number of available metrics.

“If everything is a priority, nothing is a priority,” he says. “Part of a quality lead's job is to synthesize and not get distracted by the latest release, and to keep a true north ahead of you.”