Ongoing trends are likely to loom large in the realm of patient safety this year.
A patient safety expert at The Joint Commission says four ongoing trends will dominate the patient safety landscape in 2020.
Patient safety has been a pressing issue in healthcare since 1999, with the publication of the landmark report To Err Is Human: Building a Safer Health System. Despite two decades of attention, estimates of annual patient deaths due to medical errors have risen steadily to as many as 440,000 lives, a figure that was reported in the Journal of Patient Safety in 2013.
Anne Marie Benedicto, MPP, MPH, vice president of the Center for Transforming Healthcare at The Joint Commission, recently shared her trend outlook for 2020 with HealthLeaders.
1. Patient advocacy
In 2020, there will be two primary forces at play in patient advocacy, Benedicto says.
"Healthcare providers have become more commercial in how they track patients as 'customers,' and patients are becoming more like consumers and using those skills to help navigate the healthcare system. This means more and more patients feel they have a say in what diagnoses mean for them, how they are treated, and how they engage with their care teams," she says.
With research resources such as WebMD literally at their fingertips, many patients have become savvy healthcare consumers, Benedicto says. "I see it in my personal life, where family members are doing research before they see a physician, or they make sure that they don't go to a doctor visit alone. When you are a patient and a visit is not a routine physical, you want someone else with you to ask clarifying questions because patients can be afraid or preoccupied."
Health systems and hospitals are increasingly embracing patient advocacy, she says.
For example, the Center for Transforming Healthcare is working with a Texas-based health system to boost quality improvement skills in neonatal intensive care units (NICU). The effort initially focused on clinicians, but the health system wanted to achieve quality and safety gains through empowering patients' families, Benedicto says.
"Our biggest surprise has been that the organization not only wanted clinicians trained in improvement skills but also the patient advisory council. We also provided training to parents of babies who were in the NICU for long periods of time. We found that the training gave parents permission to talk about quality issues with clinicians in a way that we had not seen before," she says.
The training for parents has focused on bridging language and skills gaps.
2. Improving the work environment
Ensuring adequate staffing at healthcare organizations is a key element of patient safety, and health systems, hospitals, and physician practices need to step up efforts to care for caregivers, Benedicto says. "This is an ongoing trend because we are already seeing clinician shortages. We are not recruiting and retaining enough medical staff members to meet the demand."
Healthcare organization leaders must shape work environments in ways that ease stress on staff members, she says.
For example, clinicians often struggle to find equipment or supplies such as medication pumps, she says. "They can spend 20 minutes looking for this equipment. It may sound like a simple inconvenience, but it can happen several times daily for a care team. When you put that all together, it can be tremendously wasteful. It also adds frustration and danger to an already stressful day."
She says "the solution to this challenge is to put the proper systems in place such as supply chain management that makes it easier for staff members to do their work."
Another way to improve the work environment at healthcare organizations is to tap into the knowledge and experience of staff members, Benedicto says. "They can not only make their workday better—they can make their patients' day better. If there is no mechanism in an organization to take those ideas and turn them into improvements, then those ideas dry up and stop coming. One of the ways we can retain people in healthcare is to make sure their voices are heard."
3. High reliability
Promoting high reliability at healthcare organizations improves patient safety and reduces wasteful spending, she says. "Going back to the example of a clinician looking for equipment or supplies for 20 minutes—that's 20 minutes of waste. That is time they could spend more cost-effectively on other issues and projects."
Falls with injury are a prime example of persistent patient safety problems that are missed high-reliability opportunities, Benedicto says. "Often, an organization will target falls every couple of years, saying that their fall rates are unacceptable. They come up with a solution, put it in place, it lasts for a few months, then the old practices creep back."
There needs to be an understanding that persistent problems in healthcare persist because they are complex, and they require structured and sustained solutions, she says. "The use of highly reliable process tools is necessary to get to zero harm. It's not just a matter of picking the easiest solution and putting it in place. It's a matter of stepping back and figuring out why the problem is happening, finding out why it is persisting, looking at the contributing factors, then developing solutions."
4. Surgery center safety
With the continuing trend of increasing numbers of procedures shifting from the hospital setting to ambulatory surgery centers, improving safety at surgery centers will be a top concern in 2020, Benedicto says.
"Technology is enabling this trend. In addition, if patients can get care in less complicated settings, then those options should be pursued. However, this opportunity comes with a risk. Many surgical centers do not have the same levels of protection that hospitals have. For example, more and more spine surgeries are happening in surgical centers, and those centers may not know what to do when there is a serious complication."
Surgery centers need to adopt patient safety protocols that have become common at hospitals, she says.
"Over the past decade, hospitals have been investing in process improvement and improvement methodologies, so they could make their care as safe as possible. That same type of trend needs to happen in other settings of care such as surgery centers. Achieving zero harm not only requires embracing high reliability as a goal, it means making sure that resources are in place to get to that goal—stronger improvement skills, stronger safety culture, and leadership commitment to zero harm."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
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Pursuing high reliability improves patient safety and reduces wasteful practices at healthcare organizations.