The Perfect Fit: Dyadic Leadership Strengthens Hospital Safety Reporting Culture
Tracks
Room 1
| Wednesday, December 2, 2026 |
| 12:10 PM - 12:30 PM |
| Plenary Room - Grand Central |
Overview
Dr Zachary Threlkeld
Speaker
Zachary Threlkeld
Stanford School Of Medicine
The Perfect Fit: Dyadic Leadership Strengthens Hospital Safety Reporting Culture
Abstract
Aim
Safety reporting coupled with continuous learning and improvement is foundational to resilient healthcare organizations, yet under-reporting persists when safety systems fail to fit the workflows of front-line clinicians. We evaluated associations between safety reporting and targeted safety activities within an established unit-based medical director/patient care manager (UBMD-PCM) dyadic leadership program at a large academic medical center. The primary outcome was total safety event (SAFE) reports.
Methods
The UBMD-PCM program—a dyadic physician–nurse leadership structure comprising 37 inpatient units—served as the platform. Starting in FY25 (September 2024–August 2025), several safety-focused enhancements were added: annual UBMD safety self-reflection, emphasis on loop closure, and alignment of unit and institutional safety goals. FY26 added collaborative UBMD–patient safety director SAFE reviews and quarterly UBMD-PCM meetings with the Director of Patient Safety. Grounded in human-centered design and commitment to learning from signals, these activities constituted a sociotechnical realignment placing clinician leaders at the center of reporting, empowering them to drive change, and establishing local trust and accountability. We compared outcomes among FY24-FY26.
Results
SAFE reports rose from 16,038 (FY24) to 18,922 (FY25; +18%) and 21,981 (+37%; FY26 annualized). March 2026 set an organizational record at 2,045 SAFE reports. Near-miss reports rose from 2,953 to 3,881 (+31%) and 4,325 (+46%; annualized). The near-miss ratio rose from 0.18 (FY24) to 0.21 (FY25) and 0.20 (FY26). At the unit level, 27 units (73%) increased total SAFE reports and 25 (68%) increased near-miss reports.
Discussion/Implications
Targeted safety activities were associated with sustained growth in reporting and an improved near-miss ratio. They occurred alongside broader institutional safety reorganization, including shifting focus from direct causal attribution to complex interactions and contributing factors. Deliberate design of leadership routines optimizes the fit between clinicians and the systems intended to surface their insights, advancing safety reporting culture from rote compliance to engagement, learning, and improvement.
Safety reporting coupled with continuous learning and improvement is foundational to resilient healthcare organizations, yet under-reporting persists when safety systems fail to fit the workflows of front-line clinicians. We evaluated associations between safety reporting and targeted safety activities within an established unit-based medical director/patient care manager (UBMD-PCM) dyadic leadership program at a large academic medical center. The primary outcome was total safety event (SAFE) reports.
Methods
The UBMD-PCM program—a dyadic physician–nurse leadership structure comprising 37 inpatient units—served as the platform. Starting in FY25 (September 2024–August 2025), several safety-focused enhancements were added: annual UBMD safety self-reflection, emphasis on loop closure, and alignment of unit and institutional safety goals. FY26 added collaborative UBMD–patient safety director SAFE reviews and quarterly UBMD-PCM meetings with the Director of Patient Safety. Grounded in human-centered design and commitment to learning from signals, these activities constituted a sociotechnical realignment placing clinician leaders at the center of reporting, empowering them to drive change, and establishing local trust and accountability. We compared outcomes among FY24-FY26.
Results
SAFE reports rose from 16,038 (FY24) to 18,922 (FY25; +18%) and 21,981 (+37%; FY26 annualized). March 2026 set an organizational record at 2,045 SAFE reports. Near-miss reports rose from 2,953 to 3,881 (+31%) and 4,325 (+46%; annualized). The near-miss ratio rose from 0.18 (FY24) to 0.21 (FY25) and 0.20 (FY26). At the unit level, 27 units (73%) increased total SAFE reports and 25 (68%) increased near-miss reports.
Discussion/Implications
Targeted safety activities were associated with sustained growth in reporting and an improved near-miss ratio. They occurred alongside broader institutional safety reorganization, including shifting focus from direct causal attribution to complex interactions and contributing factors. Deliberate design of leadership routines optimizes the fit between clinicians and the systems intended to surface their insights, advancing safety reporting culture from rote compliance to engagement, learning, and improvement.
Biography
Dr. Threlkeld cares for critically ill patients with acute neurologic illness, including traumatic brain injury, stroke, intracerebral hemorrhage, and epilepsy at Stanford School of Medicine. He completed his residency training in neurology at the University of California, San Francisco, and joined the Stanford Neurocritical Care program after completing fellowship training in neurocritical care at Massachusetts General Hospital and Brigham and Women’s Hospital in Boston. He serves as Co-Director of the Stanford Unit-Based Medical Director Program, Patient Safety Director for Inpatient Neurology, and Associate Physician Improvement Leader for the Department of Neurology. In addition to his interests in improvement science, quality improvement, and patient safety, he has a clinical and research interest in traumatic brain injury and disorders of consciousness.
