As president and CEO of the National Patient Safety Foundation, Dr. Tejal Gandhi tackles issues such as diagnostic errors and unintended harm from electronic health records. Modern Healthcare quality and safety reporter Sabriya Rice recently spoke with Gandhi about these and other concerns of the patient safety movement. The following is an edited transcript.
Modern Healthcare: What do you see as the area of most concern to patient safety advocates today?
Dr. Tejal Gandhi: I worry about complacency. We have been working on patient safety for over 15 years, and often there are new priorities that come around like population health or cost reduction. We have a long way to go yet on patient safety.
MH: Is your patient safety work shifting from inpatient to outpatient settings?
Gandhi: Expanding our work to settings outside of hospitals is critically important. Most care is given outside of hospitals. It makes sense that we started in hospitals where there's high acuity and lots of risk. There are significant safety issues that can happen in primary-care settings, in nursing homes and in home care.
What it's going to take is a better awareness of what those issues are and more leadership focus on these settings.
The third thing we need to do is develop some infrastructure, because ambulatory settings often don't have the quality and safety infrastructures of hospitals.
MH: How are electronic health records in hospital settings having an impact on patient safety?
Gandhi: The potential for enhancing quality and safety through those records is large. The challenge, though, is that often the technologies are not well-integrated into workflows so are maybe not achieving those quality and safety benefits.
They are creating some new unintended harms as well. We really need to figure out how to optimize these technologies to make sure that they're really improving quality and safety, while not creating new unintended consequences.
MH: How do you make that happen?
Gandhi: One way to improve coordination is with better interoperability and more ability to communicate information across the care continuum. A lot of organizations have been doing innovative things to help make these transitions of care across various settings more effective, such as having more person-to-person communications as opposed to just relying on paperwork; making sure patients have follow-up appointments and follow-up phone calls when they're in those transition moments; even having case managers to follow patients along all those stops on the continuum to make sure care is coordinated.
MH: Do you think that patients are involved enough now?
Gandhi: We can do a lot more in terms of communicating with patients about care plans and about risks and benefits of various treatment options. We've done a lot of work about communicating better when errors happen and when harm happens, and being much more upfront and truthful about those things. But also we can do a lot better with engaging patients in improvement work (by) asking patients about issues that are coming up and then involving them in the solutions. We often create the improvements without the patient voice at the table.