As I prepare each year for the National Patient Safety Foundation’s (NPSF) Patient Safety Congress, I look forward to the panel discussion that features members of the Lucian Leape Institute (LLI) discussing a current topic in a “town hall” format. The Congress was held last week (May 23–25) at the National Harbor complex near Washington, DC.
With my first cup of coffee early on Friday morning, prior to the LLI Town Hall opening plenary, I checked my email and took a quick look at a few listserves and other social media sites I hadn’t checked in a day or two. The world of patient safety and especially patient advocacy has a lively presence on social media these days, and last week was no exception. On Friday morning, I found strong statements from healthcare consumers about the need to engage patients in the patient safety movement and poignant stories told by patients and family members who have been harmed by preventable adverse events:
- ProPublica, a Pulitzer Prize-winning, independent, non-profit news organization, has established a Patient Harm Community Facebook page, which had 517 members early Fri. morning. For more about this community and ProPublica’s intentions, read Cheryl Clark’s column at HealthLeaders Media.
- On Wed., May 23, patient advocate and artist Regina Holliday took the Partnership for Patients to task on her Medical Advocacy blog for mishandling a planned, then cancelled meeting of its Patient and Family Engagement Network and subsequent webinar. In response, Regina has established a Facebook group called Partnership with Patients. By Fri. morning, 33 people had commented on her blog post, pledging themselves to her cause; 180 people had joined the Facebook group.
- Patient safety advocate Helen Haskell tweeted a link to Pauline Chen’s review on the New York Times’s health blog “Well” of “Love Alone,” a play about the emotional effects of a death caused by medical error.
These posts and articles convey intense and turbulent emotions, so I had to pull myself away when I realized it was nearly time for the LLI Town Hall plenary session to begin.
NPSF President Diane Pinakiewicz announced that the focus of the session would be patient engagement—clearly the topic of the day. The plenary was designed in part as a response to an article published in the Archives of Internal Medicine in February that found “In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.” They study used data from two surveys from the Agency for Healthcare Research and Quality (AHRQ): the Medical Expenditure Panel Survey (MEPS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. The article has prompted head scratching and rebuttal. At the LLI Town Hall, the article was the jumping off point for presentations about patient experience, engagement, and satisfaction. In addition to LLI members, experts from AHRQ explained the purpose and details of the patient experience surveys, emphasizing their relevance and value. NPSF titled the Town Hall discussion “Mythbusters” to register its skepticism about the study published in the Archives and to underline its belief that patient experience, engagement, and satisfaction contribute to healthcare quality and safety.
The Town Hall followed naturally on other presentations and discussions I took part in at Congress, which dealt in various ways with the need to improve the experience of care for patients and providers by improving the reliability of systems, the efficacy of technology, effectiveness of communication, and the quality of emotional support for everyone involved in unexpected outcomes and events.
LLI member Susan Edgman-Levitan launched the town hall discussion saying that if hospitals do a good job of delivering high-quality patient experience, they’ll “get everything else right.…Our patients are the only judge of leading aspects quality.”
Fittingly, Lucian Leape was asked to make concluding remarks for the LLI Town Hall. Leape brought the discussion back to basic principles, suggesting that providers apply the Golden Rule to patient experience and ask themselves, “If I were the patient, what would I need?”
Leape also proposed what he referred to as the second commandment of medicine. The first commandment is well known in patient safety: “Do no harm.” Leape’s second commandment is “Do no harm emotionally.” He commented further, “We have immense power as doctors and nurses to make our patients incredibly better or incredibly worse. Let’s make sure it’s the former, not the latter.”
Leape’s second commandment, which I’ll call “Do No Harm 2.0” was a poignant capstone to my early morning reading of direct, articulate and often raw evidence of the emotional toll of medical trauma.