Co­or­di­nated, sys­temwide ef­forts nec­es­sary to ac­cel­er­ate progress against pre­ventable harm

Modern Healthcare - - COMMENT - By Dr. Te­jal Gandhi

Pre­ventable harm in health­care is a lead­ing cause of death in Amer­ica and should be tack­led as a pub­lic health cri­sis with its own co­or­di­nated re­sponse.

A new Call to Ac­tion, de­vel­oped by the Na­tional Pa­tient Safety Foun­da­tion, pro­vides the frame­work for that re­sponse and iden­ti­fies roles for key stake­hold­ers.

The de­tailed Call to Ac­tion (avail­able at npsf.org) builds on suc­cess­ful ef­forts to re­duce health­care-as­so­ci­ated in­fec­tions and take ad­van­tage of crit­i­cal lessons learned. Es­sen­tial for this ini­tia­tive is the be­lief that a co­or­di­nated pub­lic health re­sponse—one that draws on the ex­pe­ri­ence and ex­per­tise of pub­lic health pro­fes­sion­als and or­ga­ni­za­tions—will ac­cel­er­ate progress in the pre­ven­tion of harm and es­tab­lish the crit­i­cal in­fra­struc­ture needed to ad­dress this chal­lenge across the U.S. health­care sys­tem con­sis­tently and sus­tain­ably.

That be­lief is based on Amer­ica’s long his­tory of co­or­di­nated pub­lic health re­sponses to com­bat spe­cific dis­eases and con­di­tions. Pub­lic health ef­forts have brought about a 90% de­cline in deaths from mo­tor ve­hi­cle crashes and a marked de­cline in deaths from in­fec­tious dis­ease. It’s time to put that his­tory to work com­bat­ing pre­ventable harm in or­der to im­prove pa­tient safety.

While ef­forts to im­prove pa­tient safety have been on­go­ing for sev­eral decades, the scale of im­prove­ment has been lim­ited and in­con­sis­tent. Mean­ing­ful ad­vance­ment in pa­tient safety re­quires a shift from re­ac­tive piece­meal in­ter­ven­tions oc­cur­ring at in­di­vid­ual or­ga­ni­za­tions to a co­or­di­nated, sys­temwide ef­fort geared toward pro­vid­ing safe care de­liv­ery across all as­pects of care. The co­or­di­na­tion must bring to­gether stake­hold­ers who set health­care pol­icy, de­liver care, in­sure care, re­ceive care, sup­port pa­tients, fund or re­search in­no­va­tions, ad­vo­cate in­no­va­tions and cre­ate part­ner­ships.

The NPSF frame­work con­sists of six pri­or­i­ties—each ac­com­pa­nied by a rec­om­mended ac­tion, a sug­gested tac­tic and a set of key stake­hold­ers. The six pri­or­i­ties and the rec­om­mended ac­tions are:

■ De­fine the prob­lem and set na­tional goals: Lead­ers and pol­i­cy­mak­ers must es­tab­lish pre­ventable health­care harm as a pub­lic health cri­sis and com­mit to re­duc­ing this harm across the care con­tin­uum.

■ Co­or­di­nate ac­tiv­i­ties across mul­ti­ple sec­tors to en­sure wide­spread adop­tion and eval­u­a­tion: Cre­ate cen­tral­ized and co­or­di­nated na­tional over­sight of pa­tient safety in­volv­ing a broad ar­ray of stake­hold­ers.

■ In­form, ed­u­cate and em­power the com­mu­nity: Part­ner with pa­tients and fam­i­lies for the safest care.

■ Mea­sure and mon­i­tor progress at all lev­els ef­fec­tively: Cre­ate a com­mon set of ob­jec­tive safety met­rics to en­sure wide­spread adop­tion, eval­u­a­tion and ac­count­abil­ity.

■ Iden­tify causes and in­ter­ven­tions that work: En­sure that lead­ers es­tab­lish and sus­tain a cul­ture of safety; pro­vide sus- tain­able fund­ing for re­search in pa­tient safety and im­ple­men­ta­tion sci­ence; en­sure that tech­nol­ogy is safe and op­ti­mized to im­prove pa­tient safety.

■ Ed­u­cate and train: Sup­port and ed­u­cate the work­force.

Re­sources should be ex­panded or de­vel­oped that sup­port the work­force, in­clud­ing launch­ing ini­tia­tives to im­prove work­ing con­di­tions; es­tab­lish­ing an en­vi­ron­ment of team­work and re­spect; cre­at­ing pro­grams to sup­port staff and im­prove re­siliency; and of­fer­ing fa­tigue man­age­ment sys­tems and com­mu­ni­ca­tions, apol­ogy and res­o­lu­tion pro­grams.

To em­power pa­tients and their fam­i­lies, pa­tients should be ac­tively en­gaged in care (e.g., em­ploy­ing shared de­ci­sion­mak­ing, play­ing an ac­tive role in bed­side round­ing, re­mov­ing lim­its on fam­ily vis­it­ing hours and mak­ing avail­able pa­tient-ac­ti­vated rapid re­sponse teams) and in root-cause analy­ses.

A com­mit­ment to these six pri­or­i­ties—and related ac­tions and tac­tics by the rel­e­vant stake­hold­ers—will set the na­tion on a bet­ter course for pre­vent­ing pa­tient harm. But build­ing out and im­ple­ment­ing this frame­work on a na­tional scale re­quires co­or­di­na­tion as well. If such a co­or­di­nated re­sponse can be achieved, pre­ventable pa­tient harm can be dra­mat­i­cally re­duced.

That should mat­ter to ev­ery­one, as all of us have a stake—as po­ten­tial pa­tients—in im­prov­ing the safety of our health­care sys­tem.

It’s time to re­spond col­lec­tively to a Call to Ac­tion to im­prove pa­tient safety. It’s time to drive the col­lab­o­ra­tive work needed to en­sure that pa­tients and those who care for them are free from pre­ventable harm.

Dr. Te­jal Gandhi is pres­i­dent and CEO of the Na­tional Pa­tient Safety Foun­da­tion.

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