The healthcare industry will continue to have its radar locked on the issue of Patient Safety in 2017. Some of the targets and goals are only vaguely visible from the 30,000-foot level, while others are in clear focus on the ground before us. Depending on where you stand (or fly), opportunities abound to improve patient safety. Let’s take a forward look into 2017, starting high in the clouds and descending eventually to earth.
Soaring at 30,000 Feet: The Current State of Patient Safety
In 2015, an expert panel convened by the National Patient Safety Foundation (NPSF) published a report entitled “Free from Harm – Accelerating Patient Safety Improvement Fifteen Years after To Err is Human”. This report provided many high-level observations, conclusions and recommendations that serve as an overview of the future direction of patient safety. The NPSF panel summarized the current state of patient safety by concluding that improving patient safety is a slow, complex issue that requires system-level solutions that focus on teamwork, culture and patient engagement.
Recommendations for System-Level Solutions
As we endeavor to speed up the pace of improving the complex problem of patient safety using a systems approach that focuses on teamwork, culture and patient engagement, the centerpiece of the NPSF report is a set of 8 system-level “Recommendations for Achieving Total Systems Safety”; each is accompanied by suggested tactics aimed at specific stakeholders in the system of healthcare. There is particular emphasis on leadership and patient involvement, as well as a long-overdue recognition of the importance of the well-being and safety of the healthcare workforce.
Improving Diagnosis in Healthcare from the Health & Medicine Division (HMD)
A second report from the Health & Medicine Division (formerly Institute of Medicine) entitled Improving Diagnosis in Healthcare gets more clinical. In this detailed report, the authors discuss the diagnostic process and the starring role that diagnostic error plays on the stage of patient safety. One outcome is a list of “Goals for Improving Diagnosis and Reducing Diagnostic Error.” The report shares and endorses system-level solutions found in the NPSF paper (leadership, safety culture, teamwork, technology, funding). In addition, it gets closer to ground level by making three recommendations that providers can begin to utilize to change clinical behaviors:
- Enhance healthcare professional education and training in the diagnostic process.
- Develop and deploy approaches to identify, learn from, and reduce diagnostic errors and near misses in clinical practice.
- Develop a reporting environment and medical liability system that facilitates improved diagnosis by learning from diagnostic errors and near misses.
I would submit that the reports from the NPSF and the Health & Medicine Division describe the necessary high-level approaches to patient safety that require the participation of everyone who affects healthcare, including hospitals, providers, professional societies, researchers, vendors, legislators, government agencies, PSOs and consumers.
However, after reading the reports I will admit that I was left feeling a bit powerless to further the patient safety agenda as a single individual or within a small group. To that end, let’s descend even closer to earth and consider issues that hospitals and healthcare providers face on a day-to-day operational basis. The CMS Value-Based Purchasing Program and The Joint Commission National Patient Safety Goals serve as added resources that help tie together the issues of quality, safety, and even cost.
The “Safety Domain” of CMS Value-Based Purchasing
Just in case you have been under a rock for the past decade, this serves notice that reimbursement in healthcare will be increasingly tied to clinical performance measures. The Safety Domain of the CMS Value-Based Purchasing Program will comprise 25% of the total program. Plain and simple, hospital reimbursement will be hugely affected by the outcomes resulting from the clinical practice of its physicians, advanced practice clinicians and nurses. We are definitely out of the clouds here, as patient safety becomes more concerned with the tangible earthly issues of childbirth and preventable infections on the list of reportable metrics:
- The rate of elective delivery prior to 39 completed weeks gestation
- CLABSI – Central line-associated bloodstream infections
- CAUTI – Catheter-associated urinary tract infections
- SSI Colon – Surgical site infections following colorectal surgery
- SSI Abdominal Hysterectomy – Surgical site infections following abdominal hysterectomy
- C. difficile infections
- MRSA bacteremia
2017 National Patient Safety Goals (NPSGs) from The Joint Commission
NPSGs were established long ago by The Joint Commission to help accredited organizations address specific areas of concern regarding patient safety. The list for 2017 is a mishmash of very achievable goals that provide for a system safety net in an environment where common human errors continue to threaten the health and safety of our patients. Think:
- Identification of patients
- Staff communication
- Medication and alarm safety
- Prevention of surgical mistakes, falls, decubiti, and infections.
The Focus of Patient Safety for 2017
The key words for patient safety in 2017 would include at least the following:
- Patient partnerships
- Medication safety
- Preventable infections
- Diagnostic error
- Workforce wellness.
Whether you are flying high in the clouds or digging in the trenches, the reports with lists of measures, recommendations and goals should provide more than enough fodder and fuel to focus our efforts to improve patient safety in 2017.