Time for the Patient Safety Movement to Coalesce for Greater Effectiveness

Feb. 1, 2007

Much as we discovered the AIDS epidemic in 1981 and West Nile Virus in 2004, the medical profession and the population at large first discovered the epidemic of medical errors through an Institute of Medicine (IOM) report in 1999. It has become customary to point to that report as the galvanizing moment in the history of patient safety. Since then, patient safety has become a necessary and recurring mantra, fueled by the formation of numerous groups and organizations, each coming at the medical errors issue from a unique angle.

Much as we discovered the AIDS epidemic in 1981 and West Nile Virus in 2004, the medical profession and the population at large first discovered the epidemic of medical errors through an Institute of Medicine (IOM) report in 1999. It has become customary to point to that report as the galvanizing moment in the history of patient safety. Since then, patient safety has become a necessary and recurring mantra, fueled by the formation of numerous groups and organizations, each coming at the medical errors issue from a unique angle.

Despite a flurry of activity in the past seven years, there is also a growing consensus that not much has really been achieved since the original IOM report and the follow-up reports, Crossing the Chasm and Achieving a New Standard of Care. A published study by HealthGrades in April 2006 shows total patient safety incidents growing from 1.18 million to 1.24 million in the 40 million hospitalizations covered under Medicare from 2002 to 2004. The IOM subsequently issued a fourth report, warning a weary and wary public about medication and prescription errors that injure 1.5 million Americans each year and cost the system $3.5 billion.

In late 2004, Robert M. Wachter wrote and published in a business healthcare trade “The End of the Beginning: Patient Safety Five Years after ‘To Err is Human.’” In this article, he observed that “we appear to be at ‘the end of the beginning’” of what he thought was Phase One of the patient safety response.

Ready for the Next Step
Although progress has been made in identifying the problems and building the foundation to begin addressing the myriad patient safety challenges facing the healthcare sector, efforts to date have been fragmented. Phase One might be remembered as a time in which the infrastructure for problem solving was organized and developed. It now appears time for a Phase Two, when that fragmented power is leveraged into a coalescing force.

An inventory of Phase One indeed shows much awareness building, creativity and earnestness in addressing a complex and vexing issue. Public and private patient safety organizations have sprung up to address medical errors from a variety of angles. The various organizations can be grouped generally into a few categories: 1) federal agencies (AHRQ, Centers for Disease Control, IOM and even the Food and Drug Administration); 2) public/private partnerships such as the National Quality Forum, The Leapfrog Group and the Foundation for Informed Medical Decision Making; 3) Congress (Government Accounting Office); and, 4) Private interests including the American Association of Retired Persons, Institute for Healthcare Improvement, Institute for Safe Medication Practices and professional/provider-based groups like the American Association of Critical Care Nurses and American Nurses Association.

Eliminating, for the moment, Congress and the federal agencies, most of the others are voluntary collaborations of like-minded people who see improving the system as either a vested interest or a high-minded mission. The Leapfrog Group, for example, is a coalition of large purchasers determined to improve healthcare by rewarding “leaps” in patient safety and “customer value” with preferential treatment and other market-based reinforcements.

The Institute for Healthcare Improvement, one of the oldest and best-known patient safety organizations, looks at healthcare problems from a systemic perspective and fosters collaboration rather than competition among organizations. They were the first to begin comparing safety measures in other industries, such as airlines, to healthcare and to call the healthcare industry to task. The Foundation for Informed Medical Decision Making takes yet another tack, offering patients a methodology for asking the right questions of their physicians to ensure the most appropriate care is provided and to avoid unnecessary procedures, all to ensure better patient outcomes.

If we are indeed at the “end of the beginning” of the patient safety movement, we should ask what Phase Two should look like. It seems an appropriate time for the fragmented patient safety movement to look for synergies, to coalesce around specific issues or themes that bring greater leverage and power to bear. Granted, it’s the “American way” to attack a problem independently, just as entrepreneurs start businesses, identify markets and build market share. But small businesses inevitably grow and are often absorbed into larger enterprises, which in turn use critical mass to increase market share and profits.

The problem in the patient safety business, as with all businesses, is that egos begin to get in the way and “mindshare” replaces “market share” as the measure of success, not necessarily the measure of safer outcomes.

A Look at the Future
So, what exactly will Phase Two look like? It’s important to appreciate that, as awareness of the challenge has evolved, patient safety initiatives have generally organized around six major areas: 1) state and federal regulatory and watchdog; 2) information technology; 3) error reporting and measurement; 4) working conditions and training; 5) malpractice and accountability; and, 6) research and best practices. And, others are still developing, such as informed medical decision making.

Around these general categories, more than 30 organizations have formed, although finding a comprehensive list is nearly impossible—and, of course, subject to immediate change. The categories have been defined and organized and there has been a lot of buzz and good work, but the result has been fragmented, inefficient and ineffectual.

Looking at this landscape, it is entirely reasonable to imagine disparate groups willingly coalescing around areas and issues where synergies naturally exist to work more effectively to attack their common foe. For example, the Foundation for Accountability could combine with the Foundation for Informed Medical Decision Making to gain better traction around their missions. Together, they could deliver methodologies that enable patients to have informed dialogs with their physicians, to more personally shape their own healthcare destinies and to ensure better outcomes. What’s unreasonable about that?

Similarly, the Institute for Healthcare Improvement could join with the Institute for Safe Medication Practices and/or the Partnership for Patient Safety to more forcefully foster and demand collaboration and best practices among hospitals and physician groups. Their collective leverage could be brought to bear upon managed care and insurance companies to develop premium and pricing structures based upon quality outcomes.

Each patient safety group has its own mission and integrity. Each has developed its own following and partnership network. Each has strong areas of expertise. But in myriad ways, each group overlaps either in mission, audience, approach or interest. True progress—and efficient progress—will come from capitalizing on those common intersections.

What might be some of the goals of Phase Two of the patient safety movement? Some of the real progress made has been in error avoidance and aversion. These are medical errors that didn’t happen because of best practices, better reporting, information technology tools and even improved conscientiousness from practitioners.

Unfortunately, these avoided errors are not part of the data captured, the official scorecard for patient safety, so the picture may actually be prettier than we think and than is portrayed publicly. Developing approaches, methodologies and systems to capture these avoidances would be a major step forward. It also would serve to bolster morale in the face of continued dire reporting from the IOM and others.

From Discovery to Eradication
From a strategic communications perspective, the time is ripe for the patient safety players to examine their strengths and weaknesses in regard to their peers and to look for ways to combine, integrate, strengthen and conquer—or at least make perceptible improvements in their approaches to a problem that seems to be growing despite many great and well-intentioned efforts.

A natural byproduct of coalesced groups would be clearer positioning and messaging about mission and how that mission is executed. Right now, a cursory or even detailed examination of the landscape finds some-what fuzzy, abstract definitions, overlapping of goals and objectives, and seemingly unsure tactical approaches to sol­ving problems.

From the discovery of an epidemic to its eradication is an enormous and difficult journey. It requires great will, resources, vision and hard work. The good news is that patient safety has entered the language, has become a central part of our vocabulary, and has been deeply integrated in the agendas of hospitals, providers and insurers. Putting aside egos and individual mission statements will yield a stronger consensus that not only eliminates the balkanized fiefdoms impeding progress, but also propels the reformation of a movement capable of greater efficiency, clarity and, ultimately, safety.
 

John Smith is senior vice president and director, healthcare, of Manning, Selvage & Lee in Boston. Contact him at [email protected].

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