How Authentic Presence Changes Patient Safety Outcomes

We spend a lot of time in healthcare talking about patient safety as if it were primarily the result of systems: the right protocols, evidence-based guidelines, checklists, EMR alerts, and reporting structures. These tools are essential. They standardize practice, reduce variability, and help prevent errors before they reach the patient.

But even the best-designed systems are only as effective as the people who use them. And the single most powerful determinant of whether those systems succeed or fail is something we don’t often measure: authentic presence.

Presence Is More Than Proximity

Presence isn’t about showing up on the unit or attending the safety huddle. It’s about how we show up. It’s the deliberate choice to be fully engaged — not distracted by emails, texts, or the next meeting — but sincerely focused on the people and situations right in front of us.

Authentic presence means we listen intently rather than preparing our response. We notice details others might miss. We ask questions not to challenge but to understand. And perhaps most importantly, we create an environment where others feel safe enough to do the same.

In my experience, this quality of presence can change the trajectory of care in profound ways. I’ve seen safety events averted because a nurse felt comfortable speaking up during a handoff. I’ve seen the impact of an effective time out in preventing a wrong-site surgery. I’ve seen diagnostic errors prevented because a physician paused long enough to listen to a patient’s intuition about their own body. I’ve seen entire care teams shift from a culture of blame to one of shared accountability simply because a leader chose to slow down, be present, and listen before reacting.

Presence, Trust, and a Culture That Learns

Authentic presence builds trust, and trust changes behavior. When team members trust that they will be heard and respected, they report near-misses sooner, challenge assumptions, and collaborate more effectively. That psychological safety is the foundation of what’s known as a Just Culture — an environment where accountability is balanced with learning, and where individuals are not punished for human error or system failures.

A Just Culture reframes our approach to safety. Instead of asking “Who is to blame?” it asks, “What went wrong, and how can we prevent it from happening again?” Presence is the catalyst that makes this possible. When leaders model a judgment-free zone and prioritize listening over reacting, they create space for honesty, vulnerability, and continuous improvement. That’s where safety thrives.

A Quarter Century After To Err Is Human — Why Presence Still Matters

It’s been more than 25 years since the Institute of Medicine’s landmark report To Err Is Human (1999) revealed that as many as 98,000 Americans die each year from preventable medical errors, a call to action that reshaped how we think about safety. And yet, despite enormous investments in technology, protocols, and quality initiatives, research continues to show that medical errors remain one of the leading causes of death in the United States.

We’ve built better systems, but the needle hasn’t moved far enough. One reason is that we’ve often overlooked the human side of safety — the presence, trust, and culture that determine whether those systems work as intended. Authentic presence isn’t a replacement for checklists and standards. It’s the force multiplier that makes them effective.

Lessons from the Nuclear Navy — A Call to Action from Navy Bob

Dr. Robert "Navy Bob" Roncska

Robert “Navy Bob” Roncska, DBA — a retired U.S. Navy captain who later led quality and safety at one of the nation’s largest hospital systems — brings a unique perspective in his book High Reliability Healthcare. After nearly three decades commanding nuclear-powered submarines, he warns:

“High reliability will never be built in boardrooms alone. It must live at the bedside, changing individual behavior.”

Despite running more than 150 nuclear reactors for over 70 years without a single catastrophic accident, the Navy did not achieve that record through checklists alone. Roncska notes:

“The problem is not bad people in healthcare — it is that good people are working in bad systems that must be made safer.”

His solution is deeply human: build cultures where every doctor, nurse, tech, and aide feels empowered to have a questioning attitude, act with integrity, communicate clearly, and back each other up. This is the same cultural transformation that kept the nuclear Navy accident-free — and it is exactly what healthcare must embrace to close the gap between safety goals and reality.

Seeing What Others Miss

Presence sharpens perception. When we are fully present, we’re more attuned to subtle changes: a slight shift in a patient’s mental status, a small but meaningful deviation from a protocol, or the unspoken tension in a team that signals something isn’t quite right.

These are often the early warning signs that, if recognized and acted upon, prevent small issues from becoming big problems. Conversely, when we are rushed, distracted, or disengaged, we miss them — and the opportunity to intervene slips away.

Leadership Presence Sets the Tone

The presence of leaders — whether charge nurses, department chiefs, or executives — profoundly shapes an organization’s safety culture. When leaders show up with curiosity and attention, they signal that safety is everyone’s responsibility and every voice matters. When they are distracted, unavailable, or reactive, they send a very different message: efficiency matters more than engagement, hierarchy outweighs collaboration, and speaking up may not be worth the risk.

Presence is more than a leadership style — it’s a cultural signal. And culture is the true engine of patient safety.

Daily Practice, Not a One-Time Choice

Presence isn’t a one-time decision; it’s a daily practice. It means slowing down, noticing, and choosing connection over distraction — especially in environments that reward speed and multitasking. When we commit to this practice, the ripple effects are undeniable:

• Teams function with greater cohesion;

• Patients feel truly cared for;

• Errors are caught earlier; and,

• Safety becomes part of the fabric of care, not just a metric.

Questions for Leaders

• How often do I create space to be fully present with my team or my patients?

• What cues might I be missing when I rush through conversations or decisions?

• How can I model presence in a way that strengthens trust and psychological safety?

  
  

Key Takeaway

High-quality, safe care depends on how leaders show up. Authentic presence isn’t a “soft skill.” It’s a clinical competency and leadership imperative — one that amplifies every safety system we’ve built. As Navy Bob Roncska warns:

“We have the equivalent of a 747 crashing every day in U.S. healthcare, yet those tragedies rarely spark the change they should.” 

When leaders bring authentic presence, they create the trust and vigilance needed to stop those preventable tragedies and make high reliability healthcare real.