By Leah Binder, for Forbes. Apr. 9, 2021.
We should rely on hospitals as premier authorities on protecting people from health hazards like infections and injuries. After all, they hire exceptionally smart and credentialed staff to care for the most vulnerable people in our communities. But statistics suggest otherwise. Preventable errors, accidents, and infections at hospitals are so common they rank as the third leading cause of death in the U.S., with an estimated 20,000 avoidable deaths a month. At least one in six people admitted to an American hospital suffered a hospital-acquired infection—long before we heard of SARS-CoV-19.
Sadly, after a tumultuous year of pandemic, it appears many hospitals are emerging worse, not better, at keeping patients safe.
According to a new white paper by Press Ganey, one of the country’s largest and most influential health care quality companies, “safety culture” scores declined significantly among a sample of 54 hospitals across the country. Assessed through an anonymous survey at each hospital, safety culture describes whether the norms and habits of staff and clinicians keep the focus on patient safety. Questions on the survey are extensively tested and validated by researchers, and studies show the results correlate closely with actual rates of avoidable harms, errors, and infections. A separate examination of 160 hospitals by the Agency for Healthcare Research and Quality (AHRQ) found similar results, including an alarming 40% reduction from 2018 to 2020 in staff perceptions that management made safety a priority.
Press Ganey found that safety culture declined last year in two of three categories measured. First, they found decline in the category “Prevention and Reporting,” which explores whether staff believe the hospital actively attempts to improve patient safety and whether they feel free to raise concerns.
“Given that everything was in crisis mode, it appears people didn’t feel that safety concerns were being addressed or they weren’t comfortable speaking up,” said Tejal Gandhi, MD, MPH, CPPS, Press Ganey’s chief safety and transformation officer. She finds this “disappointing, but not surprising” given the challenges organizations were facing. “It shows that all of the work on safety culture has not become hard coded or habit and that it could deteriorate under stress, which is exactly when you need that culture to be strongest.”
The category of safety culture Press Ganey found most in decline is “Resources and Teamwork,” which covers communication and collaboration between physicians, nurses, and others, as well as overall staffing levels and job stress. Gandhi says this reflects the unique demands of Covid-19, but it is alarming nonetheless. Breakdowns in communications, as well as understaffing and job stress, are rapid and persistent drivers of safety problems and extremely dangerous to patients—and to workers themselves.
Only one category remained stable since 2019, “Pride and Reputation,” which is whether staff would recommend the hospital to family or friends. “People have pride in how their organizations were responding to Covid, and they knew that leaders were trying to do the right thing,” Gandhi explained.
How Hospitals Can Move Forward
“Though safety culture has declined, hospital leaders can take action to reverse the downward trend,” Gandhi urges. “Safety culture was critical before the pandemic, but as we emerge from this crisis, it is critical that we course-correct to ensure we achieve the safest care going forward.”
Tools are abundant, and many are free or low-cost for hospitals to correct this troubling safety trend. The National Action Plan to Advance Patient Safety, an important consensus document by leading experts on best practices, was issued last fall. Other resources and tools are available from AHRQ.
Studies have shown the advantage of scientifically grounded strategies like “High Reliability” or “Lean/Six Sigma” processes to dramatically improve safety. The key to making them work is leadership, according to author Mark Graban, a prominent authority on Lean/Six Sigma principals. Leaders should pinpoint organizational problems—no matter how seemingly small—and clear barriers to solutions and coach the problem-solvers.
Safer hospitals are better for workers and vice-versa. “Workers who know that their leaders are demonstrably committed to their safety and their patients’ safety as a precondition of any other work— and not a tradeoff with other goals—are empowered to perform at their highest level,” said Ken Segel, a noted quality improvement expert and CEO and managing director of the safety organization Value Capture.
National Policy Action
There are several bipartisan policy proposals circulating in Washington to address patient safety, and the Press Ganey paper reinforces the urgency for Congress to act.
The Patient Safety Movement Foundation has a series of proposals to improve transparency and align payment for health services with excellence in patient safety.
An initiative by AARP and others (including my organization) would mandate reporting of health care acquired infections by all facilities, like ambulatory surgery centers and long term care facilities, beyond the subset of hospitals required to report currently. The Centers for Disease Control and Prevention has a small but effective operation in place to accomplish this goal called the National Healthcare Surveillance Network (NHSN), which works with all 50 state health departments to collect and analyze infection data. However, few facilities are required to report the data to NHSN, so most do not. As a result, during the pandemic, policymakers were significantly delayed gathering accurate infection data from critical hot spots like nursing homes, which in turn delayed response. That should never happen again.
An influential coalition of national advocates, spearheaded by the Jewish Healthcare Foundation of Pittsburgh, aims for the establishment of a National Patient and Provider Safety Authority, modeled after the National Transportation Safety Authority (NTSB). This would lend needed national focus to the issue and ensure we make progress when there is a crisis the way NTSB does when there is a crash.
These proposals for action would solidify our national commitment to safety and guarantee transparency and accountability going forward. We cannot allow the bitter irony of setbacks in fighting infections after we just fought the most dangerous infectious disease in modern history. We need action now.