Some 2,400 years after the Hippocratic Oath addressed protecting the sick from harm and injustice—and decades after healthcare regulations made patient safety a central mission—we’re still asking: Why is achieving and maintaining a safe, reliable patient care environment so difficult? The pursuit of continuous improvement is why we have a highly regulated healthcare industry today, focused on safety, and with steep penalties for noncompliance.
Healthcare’s collective knowledge about what’s working and what’s not for patient safety continues to build at the global, national, and local/organizational levels. Each step brings us closer to a clearer picture of how to emulate and adopt successful safety tools and initiatives for the greater good.
What is safety in healthcare?
Making healthcare safe for patients is a vast undertaking requiring strategic, clinical, and operational efforts across an enterprise. Patient safety in healthcare is linked to a large number of efforts, among them:
- Patient-centered care
- Quality improvement and pay for performance (value-based care)
- Incident management and event reporting
- Reduction of adverse events/avoidance of preventable patient harm
The systems built around these goals and initiatives strive to identify risks in healthcare and establish solutions to remedy them. The solutions take the form of laws and government regulations, hospital accreditation bodies’ standards, individual organizations’ policies and procedures, and guidance from trusted, independent associations and partners (e.g., the American Medical Association and the Institute for Healthcare Improvement).
There are so many interrelated patient safety activities and “rules” in any healthcare system, in fact, that the only way for healthcare organizations to track and report on them is to use a holistic technology. For example:
- Provider credentialing, privileging, and performance monitoring affect patient safety by admitting only qualified and currently competent caregivers.
- Workforce management and staffing decisions affect the safety of patients, clinicians, and the entire organization, helping to avoid errors, lawsuits, and adverse events.
- Monitoring the comings and goings of visitors reinforces patient and staff safety, and denies access to unauthorized individuals who seek physical or virtual access.
- Vendor management goes beyond monitoring physical access, to ensuring compliance that guards against loss of access to federal and state healthcare funding programs and exposure to civil monetary penalties
- Revenue cycle and reimbursement, too, are increasingly affected by patient safety and quality outcomes.
- Compliance, quality, and safety monitoring ensure a safe, high-performing, high-reliability healthcare environment.
Where is patient safety a concern?
Hospitals aren’t the only healthcare sites concerned with safety in healthcare. To strive for safer conditions and to root out potential harm, healthcare must follow the patient. Today, that means ensuring the delivery of safe care wherever patients seek treatment, such as:
- Physician practice office
- Retail locations’ pharmacies (e.g., CVS, Walgreens, etc.)
- Urgent care centers, whether hospital affiliated or standalone
- Specialty clinics
- Any site where telehealth is delivered and received.
And there aren’t just more sites for patient care. Now, increasingly complex care is delivered in them. For example, some medical advances (e.g., minimally invasive and peripheral procedures) no longer require a major open surgery and the equipment and staff once located only in a hospital. The number and type of procedures performed in office-based settings by surgeons, gastroenterologists, ophthalmologists, radiologists, dermatologists, and others continues to grow significantly. Telehealth expands more providers’ reach into more homes—or any site.
Urgent care, retail sites, and office-based practices are not subject to the same local, state, and federal regulations as hospitals or ambulatory surgical centers (ASCs). However, all healthcare settings share the goal of improving patient safety, including keeping their processes current, according to the Medical Group Management Association (MGMA).
What bodies oversee safety?
Various federal and state agencies govern healthcare safety compliance. For example, the Drug Enforcement Administration (DEA) and the Food and Drug Administration (FDA) both regulate the creation and distribution of medication. They ensure the safety and efficacy of medications, biological products, and medical devices. The FDA also provides the public with accurate, science-based information.
The Joint Commission (TJC) and Det Norske Veritas (DNV) accredit and certify organizations, mostly hospitals and healthcare systems, that meet certain compliance standards in healthcare for patient care quality and safety. The National Association for Healthcare Quality (NAHQ) fulfills a role similar to TJC and DNV, but primarily for health plans and credentialing verification organizations.
The Centers for Medicare & Medicaid Services (CMS) and other payers have also implemented various quality initiatives to promote safe, high-quality healthcare through accountability and public disclosure. These measures play an important role in patient safety, quality improvement, pay-for-performance models, and public reporting. In addition, the Agency for Healthcare Research and Quality (AHRQ) provides a host of resources to help healthcare organizations provide safe, high-quality care.
And, of course, each healthcare organization's administration, working in concert with frontline clinical and operational staff, ensures that policies and procedures keep a uniform and safe, person-centered approach enterprise wide.
Four safety strategies for hospitals
It’s impossible to capture an exhaustive list of modern patient safety techniques and guidelines in one article. However, we list some of the most promising and effective strategies here.
1. Patient-centered care & patient participation
In patient-centered care, an individual’s specific health needs and desired health outcomes are the driving force behind healthcare decisions and quality measurements. Consider that patients are the only ones who pass through the entire care process. As a result, they’re poised to contribute some of the most insightful information for improving an organization’s safety policies. They can identify any hidden imperfections in processes, and often their suggestions require only minor adjustments that can make a big difference in improving quality and safety.
When talking about unsafe care, in general we think of adverse events or risky situations. However, from a patient's perspective, inadequate communication, feelings of unfair treatment, or poor conditions in the facility are all factors that may evoke feelings of insecurity. The ladder of participation is a useful tool to give patients a voice and to encourage patient-centeredness and patient participation.
2. Quality management and data analysis
To ingrain quality and safety into providers’ daily activities, and to pursue continuous improvement, a digital quality management system is required. A robust system is web-based, secure, user-friendly, and configurable to bylaws, workflows, and policies and procedures. It will cover, for example:
- Professional practice reporting
- Peer review
- Incident/event reporting
- Complaints registration and audits
Data analysis tools are crucial to managing quality and safety for compliance across an enterprise, to make the small adjustments that keep patients safer, and to achieve strategic objectives. At the macro level, dashboards are a powerful tool for internal communication about improvements. They not only allow better understanding of the number of reports, but can also be used enterprise wide to share improvement actions, thus allowing disparate facilities or departments to adopt each other’s successful improvement actions. This promotes the total learning capacity of the organization.
3. Incident management
Today’s methods of shared accountability for healthcare safety carve out a role for everyone—staff, clinicians, administrators, patients, and even visitors—to effect positive change. Like the “see something, say something” campaign that Homeland Security uses to build awareness and to educate the public about the importance of reporting safety issues, in healthcare it takes a collective effort, too.
Incident management enables sharing the accountability for patient safety. It’s defined as a process to collect data on incidents and near misses, analyze and report on the information, and learn from the events toward the goals of greater patient safety and quality. Incident management in action might mean tracking a reported patient complaint through analysis to outcome. Alternatively, it can be used to identify when equipment, processes, or policies fail or are not adhered to and may require revision. The goal is to develop a robust program that encourages everyone to report incidents, near-misses, and errors in a blame-free environment.
4. Continuous improvement culture
A structural approach to achieving safety and quality in any healthcare organization requires a proactive improvement culture—which includes a safe reporting environment. The framework for creating such a culture might include the following:
- Ensure a safe and open reporting culture using Just Culture.
- Make it clear why incidents must be reported. After all, each incident is a learning opportunity and an opportunity to improve safety in the workplace.
- Be transparent about what happens after mistakes or adverse events occur, what the follow-up actions are, who is involved, and what is expected/provided for all affected.
- Involve staff and patients by asking them to contribute ideas for improvement actions and the assessment thereof.
Valuable information comes from creating an environment where all healthcare participants strive for continuous improvement. But the strategy works only if participants understand that no matter how small the improvement seems, it can make a big impact. Further, they must be afforded access to improvement tools and encouraged to speak up amid a culture of transparency and blamelessness.
symplr’s Patient Safety solutions assist customers worldwide with patient safety, continuous quality improvement, incident reporting, analysis, process automation, and more. Let us help you achieve a safer healthcare environment.