Meet Deborah Small – CNO at Cleveland Clinic, London

We all have a part to play in patient safety.  In observance of Patient Safety Awareness Week, we spoke to industry leaders to get their thoughts on topics like notable changes in patient safety, how to create a patient safety-first culture, and challenges healthcare systems are currently facing.

Meet Deborah Small, MSN, DNP, Chief Nursing Officer at Cleveland Clinic, London. Deb has had the opportunity to lead the operations of nursing departments in various types of organizations- from a rural community hospital to a system the size of the Cleveland Clinic. She is currently leading the clinical operation at the Cleveland Clinic in London, scheduled to open in 2021.

What opportunities do you have to influence future patient safety in your current position, when you are truly involved on the ground floor?

Building a new hospital provides the opportunity to better understand the complexity of the work environment and engage in strategies to make early safety improvements. For example, we are developing each policy and care path to assure we have the latest evidence-based practice incorporated to standardize processes and decrease variation in practice.

What do you think are the biggest challenges to the delivery of safe patient care?

I think the 3 biggest safety challenges for nurses are feeling empowered to “speak up” for safety, lack of appropriate resources, and workforce shortages.

As a leader, what measures do you take to assure nursing staff feels a sense of empowerment and confidence to speak up when they feel that patient safety may be at stake? 

Establishing the “speak-up culture” starts with relationships and establishing a culture of trust. Assuring competency, knowledge, and teamwork are key to supporting the confidence of each nurse to raise issues and ask questions. Incorporating “huddle” concepts and escalation protocols promote the encouragement of staff to speak out and share concerns.

Can you give an example of how an observation voiced by nurses led to safer, higher-quality care?

We should not be surprised that nurses have the most amazing ideas to improve care and safety! One of my most recent examples, before I came to London, is the automation of frequent rounding on the mental health unit. At the suggestion of staff nurses, we leveraged technology-driven workflows, eliminating guesswork, and leading to regular frequent rounding to improve patient safety.