Lessons in safety from the U.S. Navy

Veterans Day reminds us to honor the individuals who have served, and continue to serve, our country. It’s a day to express our gratitude for the sacrifices they’ve made to protect our freedoms, as well as pay tribute to the contributions veterans make to our society.  

Our very own Steve Kreiser, CDR, USN Ret., MBA, served in the U.S. Navy for 21 years. He recently sat down with us to share his experiences and discuss how the military, like healthcare, depends on a culture of high reliability.

Thanks for taking the time to talk with us, Steve. You served as a Navy Commander and FA-18 Pilot until retiring in 2008. Since that time, you’ve joined Press Ganey as a Safety Consultant and Partner. What role did the military play in helping you develop the skills necessary for your career today?

When I retired, I thought I would fly for commercial airlines or go into defense contracting. But then I learned about a 1999 Institute of Medicine report, which estimated that as many as 90,000 people were dying each year in the U.S. due to medical mistakes and errors. These numbers alone are staggering, but I later found out there was some really important work going on to bring aviation and nuclear safety principles into the healthcare environment to reduce errors and safety events. In many cases, these efforts have led to an 80% reduction in serious preventable events of harm.  

As I reflect on my military career, I would highlight the following three lessons and skills—skills that are applicable to improving the reliability of healthcare delivery.  

1. First, leaders need to constantly message the mission of the organization. Throughout my career, my leaders clearly messaged combat readiness, and yet they were also very clear that safety came first in everything we did. One of my squadron leaders used to say, “We’re going on deployment to defend our nation’s interests, and we’re going to bring back every sailor with every finger and every toe.” I remember that message to this day—because he said it so often, essentially aligning the organization around high performance, yet emphasizing that safety-first commitment. Healthcare leaders should think about how they constantly message their mission of providing safe, high-quality, patient-centered care to ensure that front-line staff and physicians aren’t under the unintentional impression that production, budgets, or finances come first. 
2. Throughout my naval career, we were always looking to improve processes, systems, and technology. This is an important role of leadership in any complex, high-risk industry. But leaders should also strive to continuously improve the competencies and skills of the people who work in those complex systems. As pilots, we trained constantly to hone our skills and improve performance. And we provided immediate feedback in our debriefs to ensure continuous learning. Likewise, healthcare leaders need to understand how and why people make errors, then teach, coach, and mentor their teams to reach higher and higher levels of performance, providing real-time feedback whenever possible.
3. Lastly, never underestimate the power of teamwork and camaraderie in creating a high-performance culture. Teamwork and camaraderie are built through frequent communication and mutual respect. They’re also forged through shared experiences—especially in overcoming tough problems and challenging times. I made seven long deployments over the course of my career, and flew in many combat theaters of operations. But those were the times that I became closest to my fellow pilots and shipmates. We were committed to our mission—but even more committed to each other. Caregivers have also gone through tough times. This makes it even more important for leaders to build employee engagement through regular communication (huddles, rounding, and one-on-ones) while also establishing clear signs of mutual respect (sometimes called "relationship skills”). At the same time, leaders must ensure staff members know that their own safety is paramount. Also, look for opportunities to bring the fun back to work, and reinforce that what they’re doing in caring for patients—or supporting those who do—is an important and noble mission. Make sure you thank them for their commitment on a regular basis.

You’re known as “Safety Steve.” How’d you get that nickname?

My wife Jennifer is a critical care nurse by background, and she’s now the Chief Nursing Officer of a large acute care hospital. She was the first person who started calling me “Safety Steve” after I retired from the Navy in 2008 and then switched gears to work in healthcare consulting. She knew, from my background as a pilot, that I was always very focused on safety. That mentality comes from being intimately familiar with the inherent dangers of the job. 

I’ve lost over a dozen friends and colleagues to aircraft mishaps during the course of my military career. That creates a focused sense of risk awareness that we, as pilots, don’t give up when we retire. In fact, it stays with us for the rest of our lives; we take it with us everywhere we go. I know some people kid me about being Safety Steve, but I wear it like a badge of honor. I hope the systems and structures we talk about at Press Ganey help create better safety awareness and commitment to high reliability among our clients.

I remember seeing your HX talk for the Pediatric Summit where you shared the lessons you learned from watching the Blue Angels. You covered a lot of great points, but you said something profound regarding leaders: “Attention is the currency of leadership.” Why is that so important in a healthcare setting and building a culture of reliability? 

That quote is attributed to Ronald Heifetz at the Harvard Kennedy School of Leadership. If we think of currency as a medium for the exchange of goods and services, then leaders should give great thought and care to what they pay attention to in exchange for high performance. That is a big lesson from the Blue Angels—which is certainly an extremely high-performing team. The leader of the Blue Angels—respectfully referred to as “The Boss”—is keenly interested in continuous improvement and learning, always striving to ensure their airshow is safe and looks sharp. 

The Boss sets a tone in their briefs and debriefs that encourages a wide-open acceptance of self-reporting errors and constructive criticism to ensure they are always learning and getting better. Healthcare leaders need to create a similar “mess up, fess up” culture grounded in psychological safety and a fair and just culture, so staff and physicians feel comfortable reporting unintentional errors and voicing safety concerns—without fear of repercussion, punishment, or retaliation.

In healthcare, safety is the great connector between all the work we do—HX, PX, EX, etc. Was this your experience in the Navy? Do you see any similarities between the military’s and healthcare’s approach to safety?

In the Navy, we understood that safety drives performance in all domains, and safe systems are good systems. In fact, if you aren’t performing your mission safely, then you are not performing your mission at all. If people feel safety is important to their leaders and the organization, they will develop greater levels of trust and commitment to the organization’s mission. That commitment can be harnessed to improve not only safety, but the patient and employee experience too. This virtuous cycle of improvement—safety driving engagement and engagement driving safety—is what the Human Experience is all about.

Reach out to Steve and the rest of our safety consulting team to discuss the next generation of safety and high reliability at your healthcare organization.

From all of us at Press Ganey, we want to say thank you to all the veterans and active-duty service members for your dedication to our country.