When something goes wrong in an ASC, the instinct is often to find fault fast. But the leaders building the strongest safety cultures are doing the opposite — slowing down, looking at systems first and creating the kind of psychological safety that makes staff actually report problems before they escalate.
Here’s how five ASC leaders approach accountability, and what they wish they’d done sooner.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: When a safety incident occurs, what does your accountability process look like, and what do you wish you’d built differently from the start?
Jess Doto, BSN, MSN, APRN. Medical Director of Elysara Ithaca (N.Y.) and Elysara Medical & Wellness (Huntington, N.Y.): Our approach focuses on rapid communication, documentation, systems analysis, and process improvement rather than blame. The first priority is patient stabilization and clear communication. From there, we review timelines, protocols, delegation structure, training, equipment and workflow factors contributing to the event.
Our process includes:
- Immediate escalation pathways
- Standardized incident reporting
- Root cause review
- Protocol revision when patterns emerge
- Competency reassessment and continuing education where appropriate
- Ongoing audit and documentation review
- One thing I wish more outpatient organizations built earlier is operational infrastructure before rapid growth. Many safety issues stem from scaling services faster than systems, policies, training, and oversight structures can support them.
A strong outpatient safety culture depends on clear SOPs, defined delegation, staff competency validation and communication systems that encourage early reporting before small problems become larger incidents.
Megan Friedman, DO. Chair and Medical Director at Pacific Coast Anesthesia Consultants (Los Angeles): Accountability processes need to be structured, objective and consistent. When a safety event occurs, the focus should be on fact gathering, systems analysis and clear communication rather than blame or Monday-morning quarterbacking alone. Providers are less likely to report events when they feel they will simply be nitpicked apart afterward. One thing many organizations wish they had implemented earlier is a clearer framework for behavioral expectations and escalation pathways.
Liz Hunt. CEO of Green Mountain Surgery Center (Colchester, Vt.): When a safety incident occurs, our first priority is always patient safety and transparent fact-finding rather than blame. We utilize a structured review process that includes immediate leadership assessment, interdisciplinary review when appropriate, root cause analysis and identification of both system and human contributing factors.
Accountability is important, but we approach it through a “just culture” lens. We differentiate between human error, at-risk behavior, and reckless behavior, because sustainable safety improvement comes from strengthening systems, communication pathways and escalation processes, not simply assigning fault.
One thing I wish we had built even earlier was a more formalized infrastructure for near-miss reporting and cross-department feedback loops. Some of the most valuable safety insights come from events that almost happened. Creating psychological safety around reporting and ensuring staff consistently see action taken afterward has been critical in strengthening trust and engagement in the process.
Allison Thomas, RN. Director of Clinical Services and Quality at Gastrointestinal Associates (New York City): When a safety incident occurs — whether involving a patient or an employee — we take a comprehensive approach to reviewing the event. We evaluate how and why the incident happened, identify contributing factors, discuss what could have been done differently and determine strategies to help prevent similar occurrences in the future. Our accountability process is centered on education, process improvement and prevention rather than blame. Looking back, one of the most valuable practices we implemented early on was the supervisors’ quarterly reviews and follow-up discussions with staff, as they have helped maintain awareness and accountability across the team.
Martha Wolf, MSN, RN. Manager of Quality & Education of ASCs of Baycare Health System (St. Petersburg, Fla.): BayCare is advancing its commitment to Just Culture across the organization as part of its journey toward zero harm. Just Culture is both a philosophy and a process that provides a structured, consistent approach to addressing errors, balancing a focus on system design with accountability for individual choices.
The philosophy of Just Culture is to respond to errors with learning, responsibility and support, while fostering psychological safety so team members feel comfortable reporting mistakes without fear of unfair treatment. It distinguishes between human error, at-risk behavior and reckless behavior. Using a structured decision-making framework, leaders assess behavior rather than outcome, hierarchy or emotion to ensure fair and consistent responses. This approach promotes shared learning, strengthens accountability and supports a culture of continuous improvement across the system.
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