Preventing healthcare associated conditions relies on the daily efforts of the frontline staff, but leadership must support them. Leaders from two major medical centers share how they ensure impact starts at the frontline.

Impact starts at the frontline For Marilou Salao, MSN, RN, PHN, CLSSGB, chief nursing officer at St. Francis Medical Center, Prime Healthcare, the concept of“ impact starts at the frontline” is rooted in the Lean Six Sigma concept of“ gemba.” As Salao interprets it,“ Gemba is going to where the work is done, because you learn the most by seeing the work being done firsthand, watching the process and then asking questions.”

“ Impact at the frontline to me is the essence of clinical care,” says Corrin Steinhauer, DNP, RN, NEA-BC, CPPS, chief nursing officer at the Arthur G. James Cancer Hospital and Solove Research Institute at The Ohio State University.“ Every time healthcare workers encounter a patient, they have the ability to impact the patient’ s clinical outcomes,” she says.

Set the right tone Fostering a culture of safety within the frontline demands leadership involvement.“ It’ s about being present,” Salao says.“ Decisions can’ t be made, suggestions can’ t be made, without really understanding the inner workings and then understanding the barriers as well.”

To help set the tone and carry it through to the frontline, Dr. Steinhauer finds storytelling to be a powerful tool:“ Finding a story that relates back to a patient’ s experience or a safety event helps capture the attention of the people you’ re speaking to,” she suggests.

Consider incorporating these storytelling moments into huddles and at the start of meetings. Discuss the tools and strategies that helped prevent an error or acknowledge an individual who took action. Dr. Steinhauer likes to take it a step further, referencing the facility’ s quality and safety goals“ to demonstrate the way all of those things are connected,” she notes.

Positive feedback Accountability is multifaceted and a key aspect of empowering

the frontline staff. Dr. Steinhauer describes formal channels— performance management and corrective action— but stresses,“ What’ s most effective, and probably the hardest to drive into a culture, is that peer-to-peer accountability.” At Ohio State, they’ ve implemented a tool called Crosscheck, encouraging staff to gently remind each other about best practices.

“ It’ s simply using language to check in with one another,” Dr. Steinhauer explains. For example, if you notice a colleague going into a patient room without sanitizing their hands, she says,“ It’ s my job to say,‘ Hey, I noticed you forgot to pump in and pump out before you went into the patient’ s room. Don’ t forget.’” This approach, she notes, is built on psychological safety, and it’ s rooted in caring for colleagues, not punitive oversight.

Building on that idea of psychological safety, Salao highlights the importance of transparency and trust.“ Your team will be transparent with you on the challenges that they’ re facing if I, as a leader, am being transparent with them,” she says.“ Once that trust is

built … the staff know they can say what they need and there’ s no fear of retaliation.”

Supporting staff and strategies with education Successful education is education that’ s ongoing and accessible. To help achieve that, Salao says St. Francis uses a mix of classes, in-services, digital modules and annual skills fairs with interactive components.“ You develop competency through hands-on learning,” Salao notes.“ You can’ t just put up a

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14 Healthy Skin Issue 16 / Fall 2025