Patient Safety: On the Marketing and Strategic Radar Screen

"Rhode Island hospital does surgery on wrong side of patient's brain--third such incident in one year at the same hospital."

"Movie star's twin infants receive 1,000 times the recommended dose of drug due to error by California hospital."

These headlines all appeared in the national press during the closing months of 2007. Almost eight years after the Institute of Medicine's landmark study, To Err Is Human, reported on avoidable hospital deaths due to mistakes or errors, and on the heels of the type of headlines listed above, there is high public awareness of medical errors--and justifiably lower tolerance for them.

A search of Google News Archives for articles with the phrase "patient safety" showed nearly 28,000 articles for 2007. Compare this with 24,600 articles for all of the years from 2001 to 2006.

Although an unscientific measure, this clearly indicates that public and media awareness about issues of patient safety has increased dramatically in the past year.

Despite recent evidence--the studies cited by the Institute of Medicine, for example--that the American healthcare system as a whole does not deliver on safety (compared with other industries, such as manufacturing, financial services, and others, and measured in terms of freedom from error or defect), the importance of safety has long been recognized.

"Primum non nocere" ("First, do no harm") is one of the early admonitions to physicians and other providers in training. That we have done a poor job of understanding and teaching how to do this has only recently been recognized.

But why should safety be of concern to marketers? The obvious answer is that your effectiveness at promoting your institution as the preferred choice for patients, physicians, and payers, and as an employer of the best providers, is at risk if medical errors put patients in peril.

Although the culture and systems at your organization that affect patient safety do not traditionally fall under the responsibility of marketing, you should be knowledgeable about your institution's record and practices with respect to patient safety, because you may be in a unique position to advance the business case for safety to strategic decision-makers and, in so doing, help patients, as well as protect and enhance the brand of your organization.

What exactly is safety, and how is it different from quality? The Institute of Medicine defines patient safety as "freedom from accidental injury." It defines error as the "failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim," including errors of commission and errors of omission and those of planning and execution. Once these nuances--small, but consequential--are considered, it is easy to see the link between safety and quality. Indeed, it has been stated that "quality healthcare is safe healthcare."

Does safety sell? On the surface, it seems a convoluted exercise to tout all the bad things that didn't happen because of your organization's focus on patient safety. It is similarly challenging to justify the return on investment in safety technology and processes to financial decision-makers. However, if your organization gets a reputation for delivering error-prone or unsafe care to patients, the damage to your brand can be irreparable.

What about quality? As the national discussion about safety and quality continues, attempts to define, measure, and reward quality--or penalize the lack of it--have proliferated. Although few patients make their healthcare and provider choices on the basis of objective measures of quality care, this is now an area of intense interest by the government and private payers, who recognize the hidden downstream and societal costs of poor quality or unsafe care. Marketers are trying to take advantage of their institution's performance on the quality "report cards" or awards promulgated by various publications, agencies, and organizations, and it is now common to hear hospital claims of being on one "top 100 list" or another with respect to quality or safety.

Sometimes, these accolades apply to such narrow specialties of care delivery or institutional characteristics that they are rendered meaningless when choosing an institution for any kind of comprehensive care. The Agency for Healthcare Research and Quality (AHRQ) has compiled a list of more than 200 healthcare quality report cards sponsored by various provider groups, health plans, private and not-for-profit organizations, and the government (www.talkingquality.gov/compendium/index.asp).

For these reasons, and because these claims are general and the agencies that confer the awards are not highly recognizable to the public, the marketing effect is likely muted.

This is not to minimize other potential benefits of such efforts, however. Although it may not resonate with the public, the standing of institutions with respect to these measures may be valuable internally to the organization to motivate improvement, as well as in negotiations with payers. For much of the public, quality of care is assumed, and to the extent an impression of quality or safety is formed, it is probably based more on the perception of service and how thoughtfully patients are treated (in a nonmedical sense).

However, it is possible that innovative efforts or programs that go beyond what is required by regulators or what is assumed by the public to be a minimum standard may capture the attention of patients, payers, or others and truly be a marketable competitive advantage.

Let's briefly look at what several providers are doing to improve safety in the area of laboratory testing and how they are distinguishing themselves in the marketplace Although medical laboratory errors may not be as frequent or serious as medication errors or surgical mishaps, recent studies show that virtually all patients have contact with laboratory testing--whether in the hospital, private office, or integrated delivery system setting.

Moreover, not only do lab test results drive much diagnostic and therapeutic decision-making--and thus determine downstream costs--but patients' curiosity about the results and meaning of their laboratory testing ranks high among reasons for doctor-patient communication, Web searches, etc. Thus, communication about lab testing and results is an important and frequent touchpoint between providers and patients.

The Palo Alto (CA) Medical Foundation (PAMF), an integrated provider organization with a strong brand in its Silicon Valley home, uses its integrated electronic medical record, linked with each patient's personal health record system, through a portal called PAMFOnline, to address an important patient safety issue involving the laboratory: failure to follow up on an ordered test result (a frequent cause for malpractice litigation). Patients can view test results and explanatory materials through this e-health initiative.

According to Paul Tang, MD, vice president and chief medical information officer, "timely access to test results is one of the most popular features of PAMFOnline because it gives patients more control over their healthcare." By making patients partners with their providers, it strengthens the brand, as evidenced by the 94% positive patient satisfaction ratings PAMF receives in surveys.

Almost half of PAMF's primary care patient base uses PAMFOnline, says Tang, including a significant percentage of its older patients, who did not grow up using electronic communication.

Giving patients direct access to parts of their medical record, such as lab test results--until recently considered taboo--is now being recognized as an important safety practice because it engages patients in their own follow-up care, serving as another safety checkpoint, according to Michael Astion, MD, PhD, director of laboratories at the University of Washington in Seattle and editor of Laboratory Errors & Patient Safety. He cites Group Health Cooperative and the University of Washington Neighborhood Clinics as organizations in the Northwest that are pursuing a strategy similar to PAMF's, again with strong patient acceptance.

Another critical patient safety issue within the laboratory is ensuring the integrity of specimen identification throughout the testing process so that the results are issued for the correct patient. The unnecessary mastectomy cited in the first headline above was the result of such a patient identification error.

Two single-specialty pathology medical groups, each with large-volume regional testing laboratories, located in different parts of the country, have invested in implementing sophisticated specimen tracking systems, which they see as both improving patient safety and conferring on them a competitive advantage in their markets.

According to Krista Crews, executive director of ProPath, a Dallas-based laboratory with a multistate market, "our mantra in the laboratory is 'Specimen integrity equals patient safety.' "

Through the use of bar coding, hardware, and software designed on-site, ProPath has identified 14 checkpoints that it tracks in the lab, where accurate specimen movement and transferal is mandatory, ensuring the integrity of specimen identification on some 1,300 patient specimens processed per day. ProPath made a four-minute video about its specimen tracking systems.

"Our safety initiative, including the video, has been a great selling point to managed care organizations and to our malpractice carrier," says Crews. "Because of our patient safety initiatives, we were granted a significant premium reduction on our latest professional liability renewal."

ProPath is beginning to market its safety initiatives to client physicians and recently distributed its first direct-to-the-patient flier explaining the "ProPath difference" and why it is important for patients to care where their biopsy is sent. Crews will also be speaking to potential physician clients at an upcoming medical specialty society meeting about the importance of specimen tracking systems to patient safety.

Cellnetix Laboratories, located in Seattle, is another large regional anatomic pathology provider. According to Donald Howard, MD, PhD, chair of Cellnetix, the company has reengineered its basic patient identification processes to improve patient safety. The opening of its new laboratory coincided with national news coverage of the unnecessary mastectomy resulting from a laboratory specimen identification error.

Local news stations, invited for a tour of the new facility, did a feature story on Cellnetix's patient safety systems in conjunction with their coverage of the national story. The story not only detailed the local lab's safety initiatives but provided additional information to patients about why not all laboratory providers are the same. It also provided viewers with a checklist of what to look for in a pathology laboratory.

Cellnetix was thus able to benefit from a national focus on patient safety by educating the public and potential physician clients about how its safety systems distinguish it from other providers in its market.

These stories indicate how a basic, even to some extent "commoditized," healthcare service like laboratory testing, for which there has not been a widely perceived difference among providers, can be differentiated on the basis of innovative systems directed at patient safety.

As the national focus on safety intensifies, organizations can "do well by doing good" if they recognize that superior patient safety is not just a regulatory i to dot but a strategic market imperative that can confer a competitive advantage for the organization.

"No organization is perfect, and it is important to ensure you are not guaranteeing perfection," says Crews. "However, taking steps to ensure the process is improved and improving is worth the effort--for the organization and certainly for the patients."