Each year, about a quarter of a million patients are estimated to be fatally harmed due to preventable medical errors in U.S. hospitals. This mid-range estimate is used in our ‘Silently Harmed’ white papers and was recently reported in May by Dr. Martin Makary of Johns Hopkins. Given this startling (and probably conservative) number, here are a few critical (yet simple) hospital-specific, patient-safety culture metrics that would be helpful for the unsuspecting public.
Most often, these metrics are only available to specific participating hospitals and the Agency for Healthcare Research and Quality (AHRQ) – the federal agency whose mission is “to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable…”
The AHRQ sponsors the development of patient safety culture survey tools for hospitals, nursing homes, ambulatory outpatient medical offices, community pharmacies and ambulatory surgery centers. As an example, the hospital survey was designed to assess hospital staff opinions concerning patient safety issues, medical errors, and event reporting. Though not mandatory, these instruments can be used by hospitals and other providers to make the following assessments of their organizations:
- Raise staff awareness about patient safety.
- Diagnose and assess the current status of patient safety culture.
- Identify strengths and areas for patient safety culture improvement.
- Examine trends in patient safety culture change over time.
- Evaluate the cultural impact of patient safety initiatives and interventions.
- Conduct internal and external comparisons.
Since 2007, approximately 30 percent of U.S. hospitals have administered the safety survey to their doctors, nurses and other healthcare workers. Survey data is collected every two years. In order to trend their results over time using the AHRQ database, hospital-specific surveys may only be up to two years old. For the most recent survey year (2016), a total of 680 hospitals submitted data, comprising approximately 448-thousand hospital staff respondents.
Four answers worth knowing
As a prospective hospital patient, I would want to know what percent of surveyed staff members responded “yes’’ to the following four questions:
- Would you have your surgical procedure at the hospital (or the department/unit) in which you work?
- Do you feel comfortable speaking up when you have a safety concern?
- Does the teamwork here promote doing what’s right for the patient?
- Are your managers and administrators responsive to your patient-safety concerns?
In order to elicit honest responses from hospital staff, confidentiality is extremely critical. If staff members feel that confidentiality is lacking, the survey becomes a meaningless ‘gamed’ response and is possibly more harmful because the rose-colored results may mislead the public. If we, the public, had access to these comprehensive and revealing standardized results every two years, we would have an easier way to assess which hospitals are safer than others.
Think about it. Would you want to seek care from a hospital where only one-third of its staff would choose to go for their own care? By making choices that are important to you and your family, hospitals would be incentivized to invest in a part of healthcare (safe care) that has been grossly neglected for decades.
Teamwork = Effective Care
One cannot underestimate the importance of teamwork when seeking appropriate and effective care. Evidence of a safe workplace culture is present when each member within a specific hospital department or clinical area:
- Is comfortable being a patient within that care unit.
- Feels comfortable speaking up when there is a safety concern.
A well-coordinated team thrives on strong communication protocols. This culture-of-safety ensures that medical errors will eventually be reduced, much the way teamwork required in a cockpit is designed to reduce pilot errors.
Not all hospitals are the same. In fact, not all departments within the hospital are the same. It’s the teamwork culture-of-safety that exists and continues within each unit of each hospital that makes the difference. The right culture will be sustained despite the turnover that invariably happens due to retirement, job-changes, etc.
Hospitals (and their associations) often debate which metrics should be used to hold them ‘accountable.’ They cite many methodological reasons why such metrics should be avoided or embraced. Some of these concerns may be legitimate. But perfect is often the enemy of good. For me, simplistic answers to the questions above will ultimately determine whether the care we seek is what we were hoping to obtain.
There is nothing wrong with keeping it simple.
To stay abreast of healthcare-related issues, we invite you to subscribe to this blog.