Culture of Safety Suffers by Penalizing People in an Imperfect System 

We have made progress on a culture of safety, but that may have been undone by the incident involving the former Vanderbilt University Medical Center nurse criminally prosecuted and found criminally liable for a fatal drug error in 2017. While individual accountability is important, more so are the systems that should be put in place to make safety achievable and sustainable. During this session, a panel of experts will discuss the case, and the impact it has had on culture of safety. The session will focus on how individuals working in healthcare quality and safety play a role in ensuring the right structures, process, and systems and leadership are in place to avoid these situations in the first place. You will leave this session with takeaways to contribute to the design and delivery of a safe care system.