Designing Reliability That Scales

High reliability in healthcare is often seen as a technical effort: checklists, training, reporting systems, and metrics. Sarasota Memorial Health Care System (SMH) demonstrates a more robust perspective.

Their experience shows that achieving reliability at scale requires deliberate design rooted in leadership expectations, governance, workforce development, and daily operations. As a public health system serving a rapidly growing region, SMH has expanded facilities, services, and workforce while maintaining exceptional standards for quality and safety.

The Context: Growth, Public Accountability, and the Stakes of Reliability

Sarasota Memorial Health Care System occupies a special place in healthcare. Governed by a publicly elected Hospital Board, SMH is directly accountable to the community it serves. Safety, quality, access, and stewardship remain top priorities, guided by public expectations and reinforced at the highest levels of governance.

In recent years, SMH has significantly expanded through new hospital openings, service line growth, and increased care for an aging population. Leaders understand that scaling quality and safety as the organization expands requires more than policies, audits, or metrics - it demands well-designed systemwide approaches to ensure reliability amid growing complexity.

"Maintaining our five-star CMS rating and Leapfrog 'A' is not a quality department goal. It's an expectation of every leader in the organization. Everyone has a role to play."

Cheryl Roberts, RN, MS, CPHQ, CPHRM, CPPS Executive Director, Quality and Risk Management - Sarasota Memorial Health Care System

Changing Perceptions: From Fear to Learning

For some, risk management in healthcare can be viewed with fear. Staff may worry that reporting a near-miss or error means "writing someone up." SMH tackles this head-on with the first question asked during an investigation - reframing it as a learning process, not a blame event.

SMH applies Just Culture principles by shifting investigations away from blame and toward system conditions, human factors, and process reliability. Leaders reduce reliance on memory by implementing forcing functions, checklists, and standardized workflows - especially within the electronic medical record.

"In every root cause analysis, we start by saying this is a learning process. Ninety to ninety-five percent of the time, we identify a process that can be improved, rather than simply attributing the issue to an individual."

Cheryl Roberts, RN, MS, CPHQ, CPHRM, CPPS

The Signal: A Surge in Reporting

One of the clearest signs that community trust exists at SMH is its strong culture of reporting. Leaders see reporting volume not as a sign of failure but as proof of psychological safety and organizational growth. The latest Culture of Safety Survey results - which are +9% above the national average for reporting patient safety events - reinforce this message.

High participation shows a shared belief that speaking up matters and that leadership will respond appropriately.

"Every report is an opportunity to learn. The year-over-year improvement indicates we are making good use of those opportunities."

Cheryl Roberts, RN, MS, CPHQ, CPHRM, CPPS

Trust Through Transparency

Trust with patients, families, and staff is further strengthened by formalizing adverse event disclosure and support processes. SMH recently participated in the PACT Collaborative, which focuses on implementing systems to ensure timely communication, peer support, and learning after adverse events or unexpected outcomes.

Multidisciplinary teams review cases together with a focus on compassion, transparency, and continuous improvement. "If we made a mistake, we admit it," Roberts explained. "We share what we've learned, what changes we're implementing, and how we'll prevent it from happening again."

"Our goal is to demonstrate through consistent action that every patient and every family matters. We are committed to learning from the past and moving forward with integrity, transparency, and compassion."

David Evans Chief Legal Officer - Sarasota Memorial Health Care System

Safety as a Shared Ownership

A key strength of SMH's culture is the high level of engagement among physicians, nurses, and allied health professionals. Safety and quality are collective responsibilities shared throughout daily clinical practice - not owned by any single role or department.

Physician leaders actively shape safety and quality initiatives, participating in nearly 20 specialty-focused quality and safety committees. They set priorities, review cases, and translate evidence into practice.

"All of our physicians are board-certified and join our organization with a clear expectation: we set an exceptionally high bar for patient safety and quality. Every physician plays an active role in achieving this standard. Many voluntarily dedicate their time to serve on department-specific Quality Improvement Committees, helping to drive meaningful progress across our system."

James Fiorica, MD Chief Medical Officer - Sarasota Memorial Health Care System

SMH has earned the Magnet designation for nursing excellence five consecutive times over 20+ years - demonstrating that safety, professional accountability, and shared governance are embedded in routine work, not dependent on individual leaders. Allied health professionals, including pharmacy, rehabilitation, behavioral health, and ancillary services, fully participate through interdisciplinary committees that influence system-wide design.

Systemization: Making Reliability Scalable

As SMH expands to multiple hospitals and ambulatory sites, leaders prioritize system standardization while maintaining clinical expertise. Risk and quality leaders are aligned by clinical domain, facilitating consistent collaboration with frontline teams across campuses.

Root cause analyses regularly involve leaders from various sites, ensuring lessons learned in one location are applicable across the system. Policies and procedures are deliberately standardized to minimize variation and confusion, especially during rapid growth.

SMH updated its incident reporting system in late 2024, enhancing usability, transparency, and feedback - reinforcing staff confidence that speaking up prompts action.

A Different View on Outcomes

SMH's culture of strong safety is validated by publicly available quality and patient safety results across both campuses. State-reported data show solid performance on key harm prevention indicators, with outcomes consistently meeting or surpassing state and national benchmarks.

Key Takeaways

Sarasota Memorial Health Care System's experience provides practical lessons for organizations aiming for high reliability amid growth: