The Hospital Board’s Blueprint for Saving Lives

Each year, far too many patients are harmed in the very hospitals meant to heal them. Research shows that one in four Medicare patients experiences an adverse event during hospitalization. Hundreds of thousands of people die each year due to medical errors. These are not just statistics. Behind every number is a name, a family, and a story that ended too soon.

The President’s Council of Advisors on Science and Technology (PCAST) recently issued a national call to action urging boards to lead a transformational shift toward safety. The message is clear: patient safety is no longer just a clinical issue. It is a board-level responsibility. Boards control the budget, set the budget, and hold leadership accountable to implement all of the evidence-based practices that prevent human errors from becoming medical errors.  The evidence-based practices are available on the Patient Safety Movement Foundation’s website. If Boards act with urgency and accountability, they can save the lives of the patients that come to their hospital. If they do not, preventable harm will persist, along with eroding trust and rising costs in our healthcare system.

Patient safety is not a problem of ideas or tools. It is a problem of leadership. Boards must set the tone, establish accountability, and demand measurable results. That begins with a practical blueprint built on three critical steps.

Step 1: Change the Narrative from Blame to Systems Thinking

One of the most pervasive myths in healthcare is that medical errors occur because of bad clinicians or isolated mistakes. In reality, most preventable harm stems from systemic failures, not a lack of skill or dedication. Poor handoff communication, fragmented data systems, and inconsistent safety protocols are often the culprits.

Evidence-based practices exist that can dramatically reduce patient harm. When I served as chairman of a children’s hospital quality committee, we went six years without a preventable death by implementing all of the evidence-based practices and focusing on system-level safeguards. That achievement was not due to the perfection of clinicians, but to the consistent use of proven practices.

PCAST confirms that while the root causes of harm are well understood, the failure to implement evidence-based practices allows harm to continue. Boards must stop asking who made the mistake and instead ask what system allowed that mistake to happen. They should also make patient safety and outcomes a standing quarterly agenda item, with transparent reporting and benchmarking against top-performing systems for outcomes, and zero as the benchmark for preventable harm.

Step 2: Demand the Use of Proven Evidence-Based Practices

The tools to save lives already exist. The Patient Safety Movement Foundation created a library of Actionable Evidence-Based Practices that address the most common and deadly harms, including sepsis, medication errors, failure to reschedule and hospital-acquired infections. These are not abstract guidelines. They are specific checklists and processes based on clinical evidence that can be adopted immediately and measured for impact.

PCAST’s 2023 report reinforces this: the evidence is clear, but implementation remains sparse, and that lack of implementation is costing lives. Hospitals that use these tools reduce complications and readmissions while lowering costs. 

Boards must require full adoption of these practices, track outcomes by harm category, and close identified gaps. The boardroom conversation should be direct and uncompromising:

• Are all of the evidence-based practices implemented across every department?
• What are the gaps? Where are we lagging?
• What is the plan to improve, and when will we see results?

Boards should not settle for promises of future pilots. They should demand measurable outcomes tied to evidence-based action today.

Step 3: Build a Culture Where Safety Belongs to Everyone

Patient safety cannot live only in the quality department. It must be owned across the organization, from the janitor to the CEO. Boards must foster a just culture where staff feel empowered to speak up without fear and where workforce wellbeing is prioritized.

A burned-out workforce cannot provide safe care. An exhausted nurse is more likely to miss subtle clinical cues. A resident physician stretched beyond capacity is more prone to error. Boards should require regular reporting on clinician harm, burnout, turnover, and psychological safety, and ensure that protective programs are adequately resourced and evaluated. When staff are cared for, patients are cared for.

Culture also depends on transparency. Too often, vendor contracts restrict data access, locking up information that could save lives. Boards must insist on HIPAA-compliant data sharing that enables insights across teams, devices, and facilities. Interoperable, real-time data systems, not siloed vendor contracts, are essential to preventing harm. With modern analytics, including artificial intelligence, these systems can even flag emerging problems before they escalate. Boards should insist that their purchasing department put language in each contract that allows free flow of data for the safety of the patient.

When safety belongs to everyone, organizations change. Staff feel supported, patients experience less harm, and boards see measurable improvements in both outcomes and costs.

The Moral Imperative to Lead

Patient Safety does not need new ideas or regulatory clearance. What it lacks is willpower at the top. We know what works. The federal government has provided the blueprint through PCAST, and the Patient Safety Movement Foundation provides the tools. What is needed now is boardroom leadership.

Every preventable death is not just a clinical failure. It is a failure of leadership. Every board has both the authority and the obligation to ensure that proven practices are implemented, that data flows where it can save lives, and that staff are cared for and have the support to deliver safe care.

This comes down to being more than compliance and risk management. It is about moral responsibility and restoring trust in hospitals as places of healing and care. And it is about creating a legacy of leadership that prioritizes human life above all else.

If boards rise to the challenge, they will leave behind more than balance sheets and capital projects. They will leave a lasting record of lives saved and families kept whole. That is a legacy worth pursuing.