Q & A with Diane Pinakiewicz
March / April 2012
Q & A with Diane Pinakiewicz
‘Patient Safety Is Everyone’s Work’
Diane Pinakiewicz has been president of the National Patient Safety Foundation (NPSF) since 2005, having been a founding member of its board in 1997. With prior experience in executive positions across a variety of healthcare sectors, Diane’s commitment to patient care has been the common thread that has taken her from her first job in hospital administration to now running the country’s premier patient safety organization. This year, NPSF celebrates the first anniversary of the American Society of Professionals in Patient Safety (ASPPS), the 10th anniversary of Patient Safety Awareness Week (March 5–9), and the launch of two new programs: the Certification Board for Professionals in Patient Safety (a certification credential in patient safety) and a 10-part online patient safety curriculum. While also preparing for the NPSF Patient Safety Congress to be held near Washington, DC, in late May, Diane sat down with Susan Carr, editor of PSQH, to discuss NPSF’s current activities and the state of patient safety in general.
Carr: Hospitals are recognizing Patient Safety Awareness Week as this issue of PSQH goes to press. What is the week’s theme this year?
Pinakiewicz: The theme of Patient Safety Awareness Week for 2012 is “Be Aware for Safe Care.” Each year since NPSF started this program in 2002, the week has had its own theme, but the program has been focused consistently on two goals: to raise awareness about patient safety and to emphasize the importance of patient/family engagement and the patient/provider relationship to the work. This year’s theme emphasizes the fact that being aware is a necessary first step to being engaged, and our materials this year are intended to help make people aware of why this issue is important, what is going on, and how to become part of the solution set. In addition, Patient Safety Awareness Week serves as a time for organizations to recognize the continuing efforts of those who work on this issue all year. It’s a time for them to reflect on the progress they’ve made, a time for people and organizations to stop and take stock internally.
Carr: Does NPSF sponsor activities as part of Patient Safety Awareness Week? The week appears to be more about local celebrations than about national public awareness campaigns. Is that right, or am I missing something?
Pinakiewicz: While the week is celebrated broadly and internationally now, you’re right that it is filled with local activities. I always hesitate to talk about “celebrating” the week because it’s a somber topic—hardly one that you’d honor with a party—and yet it is appropriate that people who spend 365 days a year committed to their patients and this work have an opportunity to stop, recognize, and congratulate themselves and each other for what they’ve accomplished while they take stock of what they need to focus on to continue to improve going forward.
The week is also a time to reflect on the importance of the provider-patient relationship and to recognize patient advocates and advocacy groups who work on patient safety 365 days a year as well. And last, one of the goals is to raise public awareness about the issue of patient safety by inspiring activities at the grassroots level within communities. Patient safety is a community issue as it affects everyone, and it will take everyone’s engagement if we are to make the progress we seek and improve our care processes so that patients are not harmed by the very systems that seek to heal them.
Patient Safety Awareness Week is celebrated in many different ways, from the issuance of state-level proclamations, to global promotion of communication tools for patients and providers, to community runs, to hospital programs that focus on singular patient safety issues, and on and on and on. People celebrate it in so many different ways and take pride in the activities they create. NPSF develops a theme each year to provide a rallying point and to capture the spirit of the week in a way that resonates with folks. We produce materials to make it easier to celebrate. For example, we can supply an image for a banner, or tent cards, and various other things that can be used to create a visible presence. We design consumer brochures that promote the theme of the week and suggest programs to further the associated learning. And we always have materials for consumers that the public can access directly and that providers can give to their patients.
This week is an example of the very essence of NPSF. Our goal is to move the patient safety and improvement work forward and engage everyone in the process, as that provides the best opportunity for success. When people feel ownership, their commitment level is higher. The fact that individuals, organizations, and communities embrace and celebrate Patient Safety Awareness Week on their own terms is what we want as we know that this is the best way to raise awareness and get the necessary engagement we seek.
Carr: Is Patient Safety Awareness Week also for patients and their families?
Pinakiewicz: Yes, a key aspect of Patient Safety Awareness Week is to focus on the value of the relationship between the provider and patients and their families.
We clearly understand the value of effective family and patient engagement, not only in contributing to safety but for optimizing the care process and potentially outcomes, too. The goal is to involve healthcare consumers in the care process and then eventually in designing solutions and health policy. At a minimum, we need to provide education, mechanisms, and support so patients can play an effective role in the care process and be full members of the team.
Part of the challenge is the fact that consumers tend not to pay attention to the healthcare system until they’re sick, which isn’t the best time to learn. And they generally aren’t aware of what’s happening on the provider side of the equation. Too often, there are more horror stories than useful information in the media.
If you think about it, it’s taken those of us inside the healthcare system quite some time to realize that we need to do things differently, that we need to look at healthcare from a systems perspective to create safer, more patient-centered processes. In all that time, as an industry, we haven’t simultaneously educated the public. How can we expect them to play the role that we know they need to play without bringing them up the same learning curve that we’ve traveled? How do you do that? Is it a public health issue? Where is the key to this? One thing is clear and should be fairly straightforward—make sure people know what’s going on in terms that they can understand and engage them so that we understand what they expect and need during the care process and in order to be contributing members of their own healthcare teams. This has been a key focus of NPSF since we were founded.
Carr: Has the task of engaging patients changed over the years?
Pinakiewicz: The consumerism movement began to gather steam and move into healthcare in the mid to late 1970s. That’s when we first started seeing a patient “bill of rights” go up on the walls of the hospitals and patient representatives begin to appear on hospital organization charts. Prior to this, patients were passive recipients of care, which we thought worked well enough for all involved as that was the way it had always been. The Internet was new, and people had access to information previously not at their fingertips—healthcare information being no exception. Patients began to arrive with questions and expect conversations in which they would be answered. Providers resisted, in part because it was a new phenomenon, challenging to their traditional roles, and in part because they felt they did not have the time necessary to be responsive. The patient was still on the outside of the team, but making it clear that this was no longer acceptable.
The entrenched culture really didn’t start to move significantly in the direction of full and appropriate patient engagement until the safety science and human factors engineering approach was applied to healthcare. As we did this, we learned the importance of a safe culture’s foundational commitment to teamwork and transparency. In healthcare, this means that the patient and patient’s family need to be part of the team and are owed complete transparency in all matters that relate to them. This requires retooling of an entrenched medical culture, which requires time, but I’m afraid that the public is understandably short on patience. We also need to do a better job of stepping this up while also making people aware of what we are doing to move in this direction.
During Patient Safety Awareness Week a couple of years ago, NPSF launched a Universal Patient Compact that we consider to be an evolution of the Patient Bill of Rights and representative of the evolution of the role of the patient in the healthcare system. It is a bilateral compact, intended to express the commitments of both the patient and the providers as they engage — the idea is to engage both sets of parties and empower the relationship between them. This compact, available at www.npsf.org, is revisited and renewed every year during Patient Safety Awareness Week in recognition of the continued evolution of the patient role and the necessary characteristics of the patient-provider relationship that will enable us all to move to a more responsive, and safer, healthcare system.
Carr: NPSF is launching a program that allows professionals to take an exam to become certified in patient safety. What can you tell us about that program?
Pinakiewicz: This is a big deal; it’s been a long time coming! This new professional credential, Certified Professional in Patient Safety, has been developed through a long and very thorough evidence-based process and will, as with any professional credential, set the standard for competency in this discipline. NPSF formed a separate credentialing board to oversee this process and confer the credential on those passing the board examination. This credential will attest to an individual’s expertise and competency in the science of patient safety and its application in the field. It will be available, as it should be, across healthcare disciplines in recognition of the fact that patient safety is everyone’s job and a team sport. As such, we are encouraging individuals to complement their other professional credentials with the CPPS credential and equip themselves with this critical expertise, so relevant and important across all of our work. The exam process for this credential will be launched during Patient Safety Awareness Week this March, which we think is a very appropriate marking of the week. The practice exam has been available on the NPSF website since February 1 and information about both can be found through a link on our website to the website of the Certification Board.
NPSF has also just launched a new online patient safety curriculum with faculty comprised of experts from the NPSF and Leape Institute Boards. The 10-module curriculum provides comprehensive foundational content on the basics of patient safety that learners can work through at their own pace. Each module has a PowerPoint lecture that advances along with an audio presentation The audio lecture can also be downloaded for MP3 players, and the slides can be printed out for note taking and review. There are essential readings and additional recommended readings, all with synopses and links for easy reference. There also are videos relevant to each module’s content, and each module contains a quiz so that the learning can be measured against stated learning objectives, particularly if the learner intends to apply for the associated CMEs (10 hours) or CEUs (10 hours) for nursing, pharmacy, leadership (ACHE), risk management, and quality management.
For latest information about NPSF’s 2012 Patient Safety Congress, visit www.npsfcongress.org
Carr: What is the intended audience for the curriculum and certification programs?
Pinakiewicz: Patient safety is everyone’s work. The curriculum has broad application for anyone who wants a grasp of the basics of patient safety and an understanding of the rationale behind the many associated activities in the healthcare field today. That includes individuals across disciplines within healthcare settings as, again, this work is not vested in one discipline or job, but is rather a team sport and that requires team training. If I were running a hospital, I would also want every one of my board members to go through the curriculum so that they had a good understanding of the reasons why the safety and quality initiatives are so important to the responsibilities they have as board members. As well, the learning is appropriate for individuals in companies that serve the delivery system so that they better understand the work of their customers and are able to respond most effectively. In the short period of time since we have launched this program, we have had physicians, nurses, CEOs, CFOs, risk managers, pharmacists, and hospital board members sign up—and that is just in the first two weeks.
There are many efforts, including those at the Lucian Leape Institute, attempting to work this learning into the educational system—into medical, nursing, pharmacy, and business schools. We also need to reach people in the workforce who haven’t been exposed to this material, who don’t have the basics in hand. The curriculum is intended to cover the basics, to supply knowledge and skills but also perspective. When a physician or nurse steps into the OR for the first time, he or she will understand why there is a checklist, why everyone introduces themselves. With this knowledge, they become part of the solution. The curriculum provides an easy, affordable way to gain this, and we are hopeful that it will facilitate spread of this critical learning.
As an added note, we have begun work on a consumer/patient/patient advocate curriculum that will convey foundational patient safety information but also focus on ways in which to engage effectively with healthcare teams, on boards and with this work.
Our board certification is intended for healthcare professionals who can evidence a level of expertise and competency in patient safety that meets the standards for the field as established by the certifying board. This is again appropriate across professional disciplines but is more targeted to professionals who seek patient safety expertise to complement their other professional training. As with the curriculum, we are already seeing individuals scheduled to sit for the exam who represent a cross section of the disciplines, which is exactly what we had expected and hoped for. Again, if I were running a hospital today, I would want someone with this credential in each of my departments so that my teams would all be driven by the same level of expertise and understanding of why this approach to the work is so important.
Carr: Approximately one year ago, NPSF launched a membership organization in patient safety. How does that program relate to certification and the new curriculum?
Pinakiewicz: The American Society of Professionals in Patient Safety (ASPPS) is an individual membership association that is unique in that it is organized around a commitment to patient safety as opposed to an individual discipline. As with the other programs, it is reflective of the full team engagement in this work and, as a group, this organization is essentially a team at a higher level of aggregation. As such, I like to say that this group is where the work gets done. It is another program that was appropriate for its time, as we saw an immediate and significant response to its establishment and it is now off and running and comprised of members from across the disciplines, along with patient advocates, students and affiliate members who just want to express a commitment to the patient safety work. We have begun to survey this group for perspective that is valuable to the field and we have already seen many of them sign up to sit for the certification exam. Those who belong to ASPPS enjoy member pricing for both the certification exam and the curriculum, among their other benefits.
Carr: Is there a way for people who don’t work in healthcare professionally to join the ASPPS?
Pinakiewicz: Yes, people who do not work in healthcare may join as affiliate members. So far, we have only a small percentage of members in that category, as we expected, with more members in our patient advocate membership category. Our goal moving forward is to find additional ways to ensure that these members are deriving value from belonging to this group and able to contribute their voices most effectively to the discussions.
We talked earlier about the challenge of engaging healthcare consumers in this work prior to their becoming involved as patients or as a friend or family member of a patient. That dynamic will be at play with respect to joining ASPPS as well, but I expect we’ll see increasing numbers of consumers and patients among our members as we expand our outreach.
Carr: What types of activities are available through the ASPPS?
Pinakiewicz: We recently launched a couple of new benefits of membership—a members-only online magazine and an initiative we call “Pulse,” which acts somewhat like a focus group and takes the pulse of the membership on current topics of focus in the field through sets of questions that can be answered online in 5 to 10 minutes. NPSF then carries the opinions forward to inform national conversations that are shaping the work. We also are launching a members’ listserv, online directory, and patient safety wiki in the next month, followed by a job board and other offerings that will be useful to those doing this work. These are all designed to strengthen the ASPPS community and support its members as they work in teams to improve the safety of the healthcare system and pursue the higher goals of improved health of the population, better patient experience and more cost-effective care delivery.