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Patient Safety Week Guest Blog 4: Be Very Afraid, Then Do Something About it

Patient Safety Week Guest Blog 4: Be Very Afraid, Then Do Something About it

March 9, 2013

Our fourth Patient Safety Week guest post is by Paula Griswold, Executive Director, MA Coalition for the Prevention of Medical Errors:

We should all be very worried about whether there will be continued improvements in patient safety. Then we should all take action and make sure there are.

I became very afraid when I read Dr. Robert Wachter’s excellent blog post “Is the Patient Safety Movement in Critical Condition?” This expert and commentator on patient safety wrote:

“…. I’ve never been more worried about the (patient) safety movement than I am today. My fear is that we will look back on the years between 2000 and 2012 as the Golden Era of Patient Safety, which would be okay if we’d fixed all the problems. But we have not.

So what’s the problem? I see two major forces slackening the response to patient safety: clinician (particularly physician) burnout and strategic repositioning by delivery systems to deal with the Affordable Care Act. Like a harried parent rushing out to the car to drive the school carpool, only to discover that he’s left his child in the house, we risk leaving behind our precious safety cargo if we fail to ensure that everybody is onboard as we rush headlong into the future.”

It’s a great post; I recommend you read the whole thing.  Here’s more…..

“The (first) problem, of course, is that nobody freed up the time to do all this new stuff….. Although many clinicians have been gratified by their work in safety and quality, I’m afraid this additional work has contributed to high levels of burnout…… seeing physicians and nurses so overwhelmed that getting them to think about anything else – safety, quality, teamwork – is nearly impossible…

“…..My second major concern about patient safety stems from the Affordable Care Act (ACA), one of whose main goals, paradoxically, is to place a premium on value over volume. You’d think that the patient safety field would benefit from such a law (which also includes significant new spending on safety), and perhaps it will… eventually. But in the short term, the ACA is yet another speed bump on the road to a safe system.

Just as physicians are overwhelmed and distracted, so too are hospital CEOs and boards. As the healthcare system lurches from its dysfunctional model to a (God willing) better place, healthcare leaders are scrambling to be sure that their organizations have seats when the music stops. The C-suite and boardroom conversations that, a few years ago, were focused on how to make systems better and safer now center on whether to become Accountable Care Organizations, how to achieve alignment with the medical staff, what the insurance exchange will mean for our reimbursement, and the like. To the degree that people remain interested in improved value, here too the emphasis has shifted from the numerator of the value equation (quality, safety, patient experience) to the denominator: cutting costs.

We simply must reorganize our healthcare systems to deliver the highest-value care. Of course, this will require big picture, strategic planning – new relationships, new institutions, new IT systems, and more. It will also depend on the creation of a bottom-up culture that allows those who deliver the care to improve it. ( my emphasis) Together, this is an awfully full agenda for both leaders and clinicians, and it is a noble one.

But as we proceed, we must remember that healthcare is delivered by real humans, working in organizations that are led by other real humans. Ignoring the pressures that both groups are under may lead us to create lovely systems and dazzling org charts for organizations that continue to harm and kill.”

Last year I wrote a guest blog post about a collaborative improvement project led by our organization, the Massachusetts Coalition for the Prevention of Medical Errors.  It demonstrated the tremendous improvement in quality and safety that can be achieved by leadership support and active engagement of front-line clinicians and staff.  I wrote:

“I am passionate about improving healthcare, to prevent harm to patients and to ensure that doctors and nurses, who entered the field to care for patients, are not devastated by their involvement in an event that instead caused harm.

What’s even more exciting is the same approach that makes healthcare safer will produce healthier patients who are happier with their care, while significantly reducing the costs of care. Hard to believe perhaps, and certainly not easy to accomplish, but true.

If we combine leadership commitment to these goals with effective engagement of front-line staff in improving processes of care, we’ll see extraordinary improvements. If we add policy and payment system changes which reward these efforts, there’ll be no limit to our achievements.”

So it is time for all of us to take action. 

We must make sure that policymakers and payment systems support health care leaders in recognizing these challenges and succeeding in this work.  They will need to continue to make improvements in safety, quality, and patient-centeredness a top priority.  They need to provide the time and resources for clinicians and front line staff to improve care processes, while they also care for patients. We cannot afford burnout of this precious resource, the healthcare workforce. We need these dedicated individuals to have the time, focus, and support to focus relentlessly on the needs of patients, and the activities to improve care processes to meet those needs.
-Paula Griswold, Executive Director, MA Coalition for the Prevention of Medical Errors