FORT HOOD, TX  –   When a patient walks through the doors of Carl R. Darnall Army Medical Center, some of the things designed to keep them safe are easy to see.

A nurse scans a wristband before giving medication. A provider cleans their hands before an exam. A surgical team pauses before a procedure to make sure everyone agrees on the patient, procedure, and site.

But much of the work that protects patients happens where they can't see it.

Darnall recently earned the Leapfrog Transparency Badge after completing and submitting all sections of the Leapfrog Hospital Survey. The badge recognizes hospitals that voluntarily provide comprehensive information about their safety and quality practices.

For Aleka Ramoutar, Performance & Quality Improvement Program manager, the recognition is about more than completing a survey. It's about showing patients that Darnall is willing to look closely at how it delivers care.

“It tells our patients that we are committed to protecting them from preventable harm by having systems in place to prevent hospital-acquired infections, medical and medication errors, and surgical errors,” Ramoutar said.

The Leapfrog Hospital Survey examines areas such as patient rights, medication safety, staffing, patient safety practices, and serious errors. Hospitals that submit the survey also receive information they can use to benchmark their progress.

“Without transparency, our organization cannot identify weaknesses, learn from our near-misses, or build the trust necessary to care for patients effectively,” Ramoutar said.

That transparency also means looking beyond what patients see.

Darnall tests its electronic health record system to ensure it can alert providers to potentially dangerous medication errors, including drug interactions, allergic reactions, pediatric dosing errors, and duplicate orders.

Patients may see a nurse scan their wristband and a medication before administering it. Behind that simple action, the hospital also monitors barcode medication administration data to identify potential problems and workarounds.

The same is true for hand hygiene.

“Patients see our staff washing their hands or using the hand sanitizer dispenser, but they do not see the rigorous surveillance program required to prove it,” Ramoutar said.

Patient safety also depends on people speaking up when something doesn't look right.

Heather Gilligan, Patient Safety manager, said Darnall uses near-miss reporting to identify potential failure points within the process before they result in patient harm. A near miss is an event that could have caused harm but didn't, either because of chance or because someone intervened.

“Every time someone speaks up, it gives us a chance to fix a process before it harms a patient,” Gilligan said.

That approach recently helped address an increased risk for potential falls in the hospital's main lobby. Staff identified a potential slip hazard at the entrance doors during wet weather. Environmental Services installed nonslip mats at the primary entrances, followed by a noticeable decline in lobby falls.

For Gilligan, that is what patient safety looks like: staff recognizing a potential risk, reporting it, and working together to make care safer.

In the perioperative area, Registered Nurse Melissa Feldner sees that same culture every day.

“All team members from the techs, to nurses, to the surgeons are empowered to speak up if a concern is identified and intervene immediately to prevent patient harm,” Feldner said.

From electronic safety checks to hand hygiene monitoring, near-miss reports, and conversations at the bedside, patient safety is built into countless moments throughout the hospital.

Ramoutar said patients may never see many of those safeguards, but they are working in the background.

“Even when they are resting quietly in their rooms, hundreds of invisible, highly sophisticated safety systems are working in the background to protect them,” she said.

And for Feldner, the commitment is simple.

“We treat every patient as though they are our own family member receiving care,” she said.

For Darnall staff, that commitment is at the heart of patient safety.