When It Comes to Patient Safety, ‘Good Enough’ Is Simply Not
By David Goldsteen, MD, MBA
In the early 1980s, when I was young in my emergency medicine career, patient safety and risk management were somewhat novel concepts in healthcare. At the time, even hand washing processes went unregimented. Medicine lacked the standardized processes and safety interventions we take for granted today, which often meant that pharmaceutical dosage or interaction errors, hospital-acquired infections, and even surgical injuries were likely common, but generally underappreciated and undocumented—and therefore relatively unnoticed.
Thankfully, that was quite a different world from the one we live in today. In just a few decades—and ushered along by watershed publications such as To Err Is Human—the industry has rallied around the interconnected concepts of patient safety and care quality. This is demonstrated daily within countless specialized checklists and infection control protocols, and reflected on a broader scale by the numerous studies, organizations, and conferences dedicated to safety and quality advancements.
Today, healthcare providers are primed and ready to embrace a culture of safety and quality. Within the last decade, we have seen an increasing movement toward value-based care, more initiatives within hospitals dedicated to patient safety, and more appointments of doctors to the C-suite: a key indicator of increasing recognition that clinical executives must help steer strategic decisions as much as financial, technical, and operations leaders do.
Yet, while we are all trying our best, it’s still not good enough for the patients who trust us with their care. A recently published paper related the results of the SafeCare Study, a group evaluation of 2,800 patient charts conducted by and among a cohort of 11 Boston-area hospitals. The researchers concluded that patient safety events are still all too common: 23.6% of all admissions resulted in at least one adverse event, of which 23% were deemed preventable. Notably, nearly a third (32%) were of serious or higher clinical severity.
While we will never fully eradicate safety events, we can ensure we manage safety better. This is especially critical now. We are only beginning to fully realize some of the pandemic’s far-reaching consequences, including extreme turnover among our most experienced nursing and clinical staff, pervasive budget cuts, and department or hospital closures, all of which threaten even the most robust quality and care safeguards. Understandably, under existential threat, financial stability has moved to become the health system’s top focus, putting it on par with or superseding quality initiatives and workforce stabilization.
As an active practitioner of emergency medicine for 20 years and a vocal patient safety advocate, I see three crucial areas in which hospitals must lean in to help rebalance care delivery around patient safety:
- Today, prioritizing a culture of safety means empowering your workforce. No one enters clinical care because it is easy. That said, healthcare’s frontline workforce has experienced more trauma, stress, and challenge over the past few years than most do in a lifetime. This highly turbulent period of turnover among our clinical care teams is unlike any the industry has experienced, exposing hospitals and health systems—and their patients—to heightened levels of risk and medical error.
In a survey of 100 hospital executives and clinical leaders conducted by healthcare consultancy Sage Growth Partners last year, 86% of respondents said burnout has led to a decline in patient safety, and 20% said it has caused patient deaths. Thankfully, the news is not all bleak: About three-quarters said the crisis has spurred critical improvement initiatives across patient, staff, and visitor safety.
With bandwidth stretched thin, hospitals must ensure staff can rely on resources that support their ability to efficiently, effectively, and safely deliver high-quality care. Executives can empower their frontline staff with safety event detection and reporting tools to seamlessly provide the insights that continuously identify and address safety gaps. Broader use of these tools is crucial to helping hospitals emerge from this trying time safer and stronger.
A workforce with longevity, stability, and bandwidth is a workforce empowered to deliver care safely and effectively. Healthcare is an emotional field, and the frontline staff truly care. Investing in their emotional well-being by listening to their needs, adopting staff safety recommendations, and ensuring everyone has breaks and adequate time off will pay dividends for years to come in care quality, patient safety, and staff satisfaction.
- Patient-centric healthcare organizations must focus on proactivity. Patient safety must be an embedded mindset in healthcare: an indisputable rule that we embrace because there’s inherent risk in everything we do, whether it’s taking an aspirin or undergoing a complicated procedure. Organizations that truly embrace this mindset have internalized an advanced definition of safety, where it has become part of their DNA.
For these patient-centric organizations, risk factors into every decision made. It’s reflected in emergency department patient triage, where care is prioritized not based on time of entry, but upon an individual’s presentation, comorbidities, and medical history.
Proactive, predictive clinical tools are needed to build this 360-degree view of every incoming patient, so that care teams can make intelligent, highly informed decisions in the seconds that matter most. When these decisions are based not on instinct or wait time, but upon a comprehensive risk profile, the resultant culture of safety leverages its evidence-based data to swiftly determine who needs immediate care. At these institutions, better outcomes mean both patients and providers win.
- In today’s data-driven world, clinical surveillance tools must be considered table stakes. As technology budgets shrink, CFOs, CTOs, and CIOs alike are scrutinizing investments and looking for creative ways to extend the capabilities of their EHR or other existing tools. Without a doubt, EHRs are the beating heart of every health system—but EHRs alone do not provide the flexibility, the rapidity, or the asynchronous surveillance capabilities to answer the question of how to optimally reduce medical errors and prevent harm. To truly advance a culture of safety, clinical teams must have access to a full suite of tools necessary for success, from advanced error detection and automated safety event reporting to root cause analysis.
Data-driven risk prevention tools can transform early risk identification measures and prevent errors from happening in the first place. They harmonize clinical data with business data to generate proactive insights that drive improvements across the hospital, from infection prevention to medication administration—and even reduce costs via staff efficiencies and improved outcomes. Hospitals must continue adopting technology that complements their EHR and enables them to leverage all that valuable patient data to help proactively identify early warning signs and prevent any compromise to patient safety before it begins.
The most exciting thing about our industry now is how ripe it is for evolution. Over the next five years, we’ll round the corner on performance-based care, which means assuming not only greater financial risk, but also greater patient risk as care events shift outside the hospital walls to less expensive outpatient arenas. Our already complicated world will continue to grow even more complex. To best manage these landscape changes, we’ll need technology to support new use cases across new sites of care, and that technology will need to advance beyond identifying safety events to predicting them on a precise level. We’ll leverage individual-level data, such as genomic-level risk data, for even more sophisticated personalized safety profiles.
But that’s tomorrow. If we don’t start that journey today, we’ll never get there. Today, right now, there has never been a better moment to more fully embrace patient safety. Together, we can—we must—move beyond “good enough.”
David Goldsteen, MD, MBA, is the co-founder and serves as chairman & CEO for VigiLanz.