From a financial outcomes standpoint, the healthcare industry has historically been metrics driven—tracking the number of procedures, bed utilization, profit and loss, etc. Financial outcomes are audited and reported each year. However, one outcome that receives far less focus is preventable medical harm.
Yet patient deaths from preventable medical harm are estimated at over 250,000 and cost the U.S. healthcare system at least $19.8 billion annually due to additional medical care and lost productivity.
On top of that, healthcare workers suffer numerous work-related injuries such as needle-stick injuries, lifting and back injuries, falls with debilitating injuries and an alarming growing number of workplace violence injuries. Suicide and burnout rates among our workforce continue to climb. So if preventable medical harm isn’t a focus at your health system, now is the time for leaders at all levels to make it a priority.
In any other industry, these numbers would not be acceptable. Yet in healthcare we continue to allow these events to occur, putting patients and staff at risk. But the Patient Safety Movement Foundation, a not-for-profit working in 64 countries and over 4,800 hospitals around the world, has called for a Patient Safety Moonshot to achieve zero preventable patient deaths by 2030.
Eliminating preventable medical deaths by the end of this decade will take Herculean efforts by all stakeholders. It will also take courage as it requires us to look in the mirror and identify where we have failed in the past. By understanding our weaknesses, leaders will be able to make better decisions and help others perform better.
There are three critical areas that must be addressed to lay the foundation needed to ensure safe, high-quality healthcare for all.
- We need healthcare system leaders, federal and state legislators, health insurers, medical societies and others to acknowledge the fact that there is a lack of transparency, especially as it relates to patient and health worker safety. The public lacks access to the patient safety data needed to make informed decisions about where to seek care. Additionally, without transparent data, shared learning and solutions that would make our work environment safer are desperately lacking.
Historically, fear of litigation, blame or loss of reputation or career have kept healthcare in a “deny and defend” culture and made healthcare providers fearful to be transparent with patients and families about medical errors. Not only does this cause harm to patients, but failure to address the underlying issues can cause more harm to a health system long term. Therefore, chief medical officers and chief nursing officers can help turn the focus to system failures instead of individual blame to improve transparency and shared learning.
To change the status quo, not only will all stakeholders need the courage to acknowledge the lack of transparency, but also commit to addressing the issue and listen to potential solutions to liberate safety outcomes data.
- Safety outcomes and healthcare incentives are misaligned. Healthcare organizations and clinicians are generally paid according to the volume of services, visits and procedures completed, rather than by quality- and safety-related outcomes. Current “pay for performance” programs have shown small successes, but they are not enough.
More outcomes tied to reimbursement are needed. While this might feel like it threatens the bottom line, the current payment models reward unnecessary care or overtreatment, which increases both cost of care and risk of harm. Therefore, chief financial officers should encourage their leadership to improve care outcomes to improve their bottom line. W. Edwards Deming long ago demonstrated that if you improve quality and reduce defects (e.g., preventable harm), you improve profit.
- The U.S. currently has no agency, authority or administration that independently reports, conducts reviews and shares patient safety learning on a national and regional level. The notion of Congress creating a National Patient and Provider Safety Board, similar to the National Transportation Safety Board focused on safety in the aviation and transportation industries, has been met with hesitancy. Concerns regarding more regulation and oversight created a negative view. However, it is the role of healthcare leaders in each organization to help dispel this fear and acknowledge how shared learnings that put evidence-based safety processes and training in place can improve patient care.
Reaching zero preventable patient deaths by 2030 is no doubt an audacious goal, but it is one that is necessary. It is important that healthcare leaders step up and work in tandem to ensure success. Patient safety needs to be embraced from the boardroom to the operating room.
