Leadership and Safety: Are You Tracking the Right Metrics?

Healthcare leaders track countless metrics – patient satisfaction scores, length of stay, readmission rates, and financial indicators. Yet one of the most critical metrics often remains unmeasured: safety-related behaviors and perceptions among staff and patients.

When we discuss safety in healthcare, conversations typically center around clinical outcomes and patient harm events. While these are undoubtedly important, they represent only part of the safety equation. 

To fully understand the level of safety in your organization, the behavioral and perceptual aspects of safety; specifically,  how staff interact with patients, visitors, and each other, and how safe people feel in your facility. These are equally crucial metrics that deserve attention from leadership.

Beyond Incident Reports

Traditional safety metrics in healthcare focus on counting negative events after they occur, such as medication errors, patient falls, or workplace violence incidents. While these lagging indicators provide valuable information, they only tell you what went wrong, not why or how to prevent future occurrences and recognize patterns that lead to violent outcomes. Forward-thinking healthcare organizations are expanding their safety metrics to include leading indicators that predict future safety-related outcomes and their root causes. These measurements and observations include:

• Behavioral observations: How often do staff members address gateway behaviors like raised voices or disrespectful language before they escalate to more serious incidents?
• Non-escalation success rates: How many potentially volatile situations were successfully defused before becoming reportable incidents?
• Psychological safety scores: Do staff members feel comfortable speaking up about safety concerns without fear of retribution?
• Communication quality assessments: How effectively do teams communicate during critical moments like shift handoffs or code situations?

The Leadership Connection

Safety metrics reflect leadership priorities. When leaders actively track and respond to behavioral safety indicators, they send a powerful message that safety is not just about avoiding harm but creating an environment where respectful communication and conflict prevention are valued.

Consider how different leadership approaches influence safety culture:

Reactive Leadership:

• Measures only incidents after they occur
• Responds with disciplinary action
• Creates a culture of fear and underreporting

Proactive Leadership:

• Measures both leading and lagging indicators
• Responds with training and encourages reporting
• Creates a culture of prevention and continuous improvement

Implementing Meaningful Safety Metrics

Healthcare leaders looking to enhance their safety metrics should consider these steps:

1. Expand your definition of safety to include behavioral indicators and perceptions alongside clinical outcomes.
2. Expand your definition of violence to include gateway behaviors and staff-on-staff, staff-on-patient, and patient-on-staff harassment and other forms of lateral violence, and measure frequency. 
3. Implement structured observation programs where trained observers document both safe and unsafe behaviors in various settings.
4. Conduct regular safety perception surveys asking staff how safe they feel, how confident they are in de-escalating conflict, and how supported they feel in addressing disrespectful behavior.
5. Track intervention attempts, not just outcomes. How often do staff members attempt to redirect escalating situations using techniques like the Universal Greeting or Beyond Active Listening?
6. Measure proximity between potential triggers and responses. How quickly do team members recognize and address gateway behaviors of violence?

Making It Matter

For safety metrics to drive meaningful change, leadership must demonstrate that these measurements matter through visible action. This means:

• Reviewing behavioral safety metrics with the same attention given to financial and clinical metrics
• Allocating resources based on these indicators
• Recognizing and rewarding teams that demonstrate strong safety behaviors
• Investing in training that addresses identified gaps

The Return on Investment

Organizations that prioritize measuring and improving behavioral safety see tangible benefits beyond reduced incident rates:

• Lower staff turnover and absenteeism
• Reduced workers' compensation claims
• Higher patient satisfaction scores
• Improved clinical outcomes
• Enhanced organizational reputation

Safety is ultimately a leadership metric because it reflects what an organization truly values. By measuring what matters, meaning the behaviors and perceptions that create or compromise safety, healthcare leaders can build organizations where patients and staff thrive.

When leaders demonstrate that safety behaviors matter enough to measure, they create workplaces where showing respect isn't just a platitude, it's a professional expectation with a genuine impact on safety and quality. In these environments, everyone understands that treating others with dignity isn't optional; it's fundamental to the organization's success, central to its mission of healing, and crucial for the safety of everyone.