In this episode of the Chief Healthcare Officer Podcast, Dr. Fatih Mehmet Gül speaks with Dr. Nicholas Testa, Chief Clinical Officer at Sentact, emergency physician, healthcare executive, and educator at the University of Southern California.
The conversation begins with a difficult question: after decades of patient safety work, protocols, root cause analyses, high-reliability frameworks, and major investment in quality programs, why is preventable harm in hospitals still rising?
Dr. Testa argues that the answer is rarely just another protocol. Even the best checklist can fail when a clinician feels it is safer to stay silent. Real patient safety depends on trust, psychological safety, accountability, leadership behaviour, and the daily culture inside hospitals.
Drawing on his experience as an emergency physician, hospital CMO, regional clinical leader across 29 hospitals in California, and now Chief Clinical Officer at Sentact, Dr. Testa explains why healthy safety cultures often report more harm events, not fewer, because people feel safe enough to surface problems.
The episode explores how healthcare leaders can build trust, manage incident reporting without creating fear, balance psychological safety with accountability, use data more intelligently, and make rounding and safety huddles part of the operating rhythm of the hospital.
If this conversation resonates with you, share it with one healthcare colleague who needs to hear it. Patient safety does not improve through quiet agreement. It improves through louder conversations in the right rooms.
Patient safety does not fail because hospitals lack protocols; it often fails because clinicians do not feel safe enough to speak up when something is wrong.
The real test of a safety culture is not what is written in the policy, but what happens in the corridor afterwards.
Hospitals that report no harm events are not necessarily safer; they may simply have a culture where people are afraid or discouraged from reporting.
A healthy safety culture often produces more incident reporting, not less, because staff trust that reporting will lead to learning rather than punishment.
Chasing “zero harm” can become counterproductive if hospitals become more focused on preserving the number than honestly naming and investigating harm.
Trust is built through consistent leadership behavior over time, especially when leaders remain calm, transparent and fair under pressure.
Leaders can unintentionally erode trust through small reactions, emotional volatility or punitive responses that make staff retreat rather than speak up.
Psychological safety does not mean being nice all the time; it means people can be honest, raise concerns and participate in difficult conversations without fear of retaliation.
Psychological safety must be paired with accountability; teams need to feel safe reporting harm, but they must also own the work required to understand and prevent it.
Incident reports and RCA findings should be treated as opportunities for learning and improvement, not as administrative burdens or blame exercises.
Healthcare leaders should question their data constantly, not simply review dashboards or accept low incident numbers at face value.
The most important question every CMO should ask is how often the organization reviews, challenges and learns from its safety data.
Safety and quality are related but not identical; safety is about preventing what should never happen, while quality is about reliably delivering what should always happen.
Technology and data are valuable only when they help hospitals connect people, surface risks and share learning across teams and institutions.
Culture change at scale requires focus, collaboration and tenacity; leaders cannot fix everything at once, but they must keep returning to the most important problems.
Clinical leaders need to balance authority with vulnerability by admitting mistakes, showing their human side and creating space for others to challenge them.
Boards and senior leaders need to understand that better reporting may initially make harm numbers rise, because transparency exposes problems that were previously hidden.
Regular leadership rounding is one of the most powerful ways to understand what is really happening with patients, families and frontline teams.
Night rounding matters because night-shift teams often feel unseen, and leaders can hear different truths when they visit the hospital outside normal hours.
Daily safety huddles help build shared situational awareness, break down silos and turn safety from one leader’s responsibility into a collective organizational habit.
