Like me, I'm sure you have thought about the case against Vanderbilt University Medical Center intensive care unit nurse RaDonda Vaught. Without knowing all of the details, particularly about the internal systems and safeguards at Vanderbilt, we can’t speak to the specifics of the case. We know the patient's death was a tragic error which every clinician fears will happen to a patient on their watch. We send our deepest sympathies to the patient’s family and to our colleague, RaDonda.
As Salem Health's CEO and as a nurse for 40 years, I am concerned that a by-product of this case will be to create fear amongst health care workers, and I want to address this fear directly at Salem Health. Fear erodes the culture of problem solving and transparency that is fundamental to our mantra, that no patient, staff or provider harm is acceptable to us.
First, let me address the issue of accountability. Accountability is important, but not always simple, in the complex world of health care. The process of care and healing is not delivered in a vacuum by a single provider. It is a complicated, coordinated team effort. With such intricacy, the standard for criminal charges should be very high, nothing short of malicious intent or gross negligence. We, and most hospitals, have a Just Culture standard and the legal system should adhere to this standard.
At Salem Health, we want to make doing the right thing easy and making mistakes difficult. In other words, which you may recognize, we want to build highly reliable systems. On their own, even extraordinary people will make mistakes, but strong systems can stop mistakes before they can occur.
This is where it gets tough. Building strong systems requires a radical commitment to something that is uncomfortable: making problems visible. It goes against our human nature to reveal a mistake or a near miss. But these are the moments when we find the weak points in our system, build a better one and prevent future patient harm. Strong systems give caregivers confidence in the midst of complex work.
Making problems visible requires courage. That's why we have built our culture on the tenet "assume positive intent" — to help create the psychological safety required to identify problems and get better every day. Within the safety of positive intent, problems turn to gold.
The RaDonda verdict could undermine our courage, and with it, our culture of transparency and our willingness to make problems visible. We won't let that happen. We will relentlessly build a culture of improvement based on the assumption of positive intent. We will advocate for liability protections that clearly define the limited circumstances when criminal charges might be appropriate. Our commitment to clinical excellence and our front-line problem solving have brought us far, and we won’t stop now.
Our safety systems can fail. People make mistakes. We need to report and problem solve those failure issues and not be silent about ways we can improve. We cannot be silent even if it means reporting errors we have made so progress can be made to eliminate them. RaDonda has not been silent about the error which occurred. She has made us stronger by not being silent. You make us stronger by not being silent. Patients are safer because you are not silent.
The word “proud” is insufficient to describe how I feel about the work of the care teams at Salem Health. Your compassion, your strength and your courage make our community a healthier place. Thank you for your commitment to our patients, and to all the problem-solving work that keeps them safe. Know that I am committed to you.