CEO of MUSC Health-Lancaster Division honored for creating culture of safety

January 04, 2023
Two men in suits smile while holding an award.
Thornton Kirby, left, president and CEO of the South Carolina Hospital Association, holds the Zero Harm award with recipient J. Scott Broome. Broome serves as CEO of the MUSC Health-Lancaster Division. Photo provided

Each year, the South Carolina Hospital Association (SCHA) recognizes a hospital leader that strives toward achieving zero harm in his or her facility. In 2022, J. Scott Broome, CEO of MUSC Health-Lancaster Division was named the Drive to Zero Harm Leadership Award winner. 

The Lancaster Division encompasses MUSC Health Lancaster Medical Center and MUSC Health Chester Medical Center along with each of their medical practices and affiliates. After assuming the CEO post in July of 2020, a safety culture survey from Press Ganey in 2021 highlighted improvements in several categories and an overall +0.26 improvement from the 2020 results. Broome explained that he focused on three pillars to create a culture of safety: reporting, learning and Just Culture. 

In order to create the culture of reporting, he said he makes it as easy as possible for his care team members to bring up any concerns. Each week, members of the leadership team visit different departments within the facilities. This allows care team members an easy opportunity to report anything that could use attention.

“My simplistic thinking about it is if a nurse on the unit identifies a process that could lead to risk for a patient, by the time that nurse goes through normal channels, files an incident report that works its way through, gets studied, and leads to a change – too much time will have passed. I don’t say this to discourage incident reporting. In fact, we strongly encourage it; however, we want to provide many inlets for information leading to improvement,” Broome said.

When it comes to learning, Broome wants to make sure that his team feels comfortable reporting mistakes and problems when they happen – without fear of negative consequences. But the fear of consequences is only one reason care team members don’t report issues. Broome explained that care team members may not believe that their reports matter. He strives to make sure reports aren’t just heard but are also acted upon. 

“If we ask people to report, they have to feel the freedom to do that, and they have to have confidence that we’re going to use the information constructively for our process improvement and education,” Broome said.

Man in a suit leans over to talk with a woman who's seated at a desk. They are in a hospital. 
Broome talks with a woman in the Lancaster Medical Center in this screenshot from a video issued by the South Carolina Hospital Association.

The third pillar, maintaining Just Culture, is about evaluating human agency – a person’s ability to make choices in a given environment and shape one’s life – in errors in a constructive manner. “Humans make mistakes, and as an organization, there can be an accumulated wisdom from reporting these mistakes, learning from them and developing processes to mitigate the risk of human error,” said Broome. 

“We have to be committed to identifying error-prone processes and minimizing the risk associated with them,” he said. “If it’s human error, what things can we put in place to provide error-proofing so it doesn’t happen again? Or if it was a process issue, we must identify what step in the process failed.”

Under Broome’s direction, hospital leaders completed Just Culture training to learn how to categorize errors and how to address them most effectively. The training teaches that errors can be categorized according to behaviors from simply human error to at-risk behaviors and, infrequently, reckless behavior.

“When human error occurs, we need to avoid negative consequences for the individuals involved, learn from it and provide reeducation as needed,” he explained.

The second category involves behaviors that may be defined as at risk, whether intentional or not. This type of error may occur when someone knowingly skips a step, often with best intentions, but is still acting against protocol. This category may also involve growing desensitization to protocols based on the repetitive nature of some tasks. In either case, unintentionally, risks are introduced. Broome also sees these as leaning experiences for his staff.

“In these cases, we need to reeducate, explain the step that was missed and that the step is part of the process for a reason, and its inclusion can prevent bad things from occurring.”

While the Just Culture training includes a third category for reckless behaviors, Broome said occurrences resulting from these errors are exceedingly rare in his experience.

“In more than 20 years in the field, perhaps there have been some, but I can’t remember any situations where there was intentional harm or something like that. Our issues are almost always in the first or the second categories,” he said.

Care team members within the MUSC Health-Lancaster Division indicate buy-in with this approach, and Broome’s focus on Just Culture is making a difference in the safety culture of their division. In the Press Ganey survey, the statements with the most improved responses were:

  • When a mistake is reported, it feels like the focus is on solving the problem, not writing up the person (+0.50).
  • Communication between physicians, nurses and other medical personnel is good in this organization (+0.46).
  • Mistakes have led to positive change here (+0.44).

Those improvements did not go unnoticed. Karen Reynolds, SCHA executive director of Innovation, said that zero harm is not simply a goal, it’s a practice – one that Broome exemplifies.

“J. Scott Broome’s commitment to ensuring high reliability and a culture of safety is at the center of MUSC Health-Lancaster Division, and the demonstrable success the organization has had stemming from his efforts is a testament to what can be accomplished when that philosophy is put into action.”

And though he said he’s honored by the award, don’t expect Broome and his team to rest on their laurels. They always see room for improvement. MUSC Health Lancaster Medical Center and MUSC Health Chester Medical Center received 11 Zero Harm awards this year under Broome’s leadership. Next year, he’d like to earn even more.

“There are plenty of additional things that we can add to that list,” said Broome. “We want to sustain the awards we got, plus add some additional awards to that list.”

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