As the healthcare industry enters the pandemic's third year, many leaders are working to reinvigorate staff and patient safety efforts.
Below are five of the most pressing safety issues for hospitals and health systems to address in 2022, based on expert insights, research findings and trends reported in the past year.
1. Foundational safety work. First and foremost, healthcare organizations must ensure they have a strong foundation to refine safety efforts and sustain improvements, according to Patricia McGaffigan, RN, vice president of safety programs for the Institute for Healthcare Improvement. Ms. McGaffigan equated it to building a house — you wouldn't add more rooms onto a foundation that isn't solid. One way leaders can strengthen the foundation for care that is safe, person-centered and equitable is by using IHI's "National Action Plan to Advance Patient Safety" as a roadmap to reinvigorate safety efforts, she said.
As part of this work, leaders must ensure they have a strong culture of safety at their organizations. A 2021 report from the Leapfrog Group found hospitals' cultures of safety have significantly decreased amid the pandemic, with many healthcare workers reporting that they are not comfortable speaking up about potential errors, according to Erica Mobley, vice president of administration at the Leapfrog Group.
"It's really critical that the systems are still in place for people to be able to speak up, for the right training to happen and to continue to build a culture of safety, regardless of what's happening in hospitals," she said.
Ms. McGaffigan recommended healthcare leaders use this blueprint from IHI and the American College of Healthcare Executives to assess the current state of their organization's safety culture and plan future priorities.
2. Supporting the healthcare workforce. Purposeful efforts to protect and support the workforce should be a crucial priority for healthcare leaders this year, according to Ms. McGaffigan. Leaders must reinforce their commitment and accountability to eliminate harm to the workforce, and that view of harm should not only include physical safety but psychological safety, joy, well-being and healthy work environments, she said. As the proportion of temporary staffing increases during the pandemic, leaders should also keep safety at the forefront of every workforce decision.
Ms. McGaffigan said IHI's National Action Plan contains various resources and strategies on promoting workforce safety. In December, the Agency for Healthcare Research and Quality also introduced new workplace safety supplemental items that can be used as part of its "Hospital Surveys on Patient Safety Culture," which can help leaders capture and act upon insights on patient and workforce safety.
3. Integrating equity into safety work. Another important focus for healthcare leaders this year should be how to prioritize and ingrain health equity into safety and quality work.
"Safety challenges arise because there is a lot of unwanted variation in systems," Ms. McGaffigan said. "Inequities are a form of unwanted variation, and they are inextricably linked to safety."
This work should start at a leader's own organization, by taking a look at their own workforce's experience and beliefs with respect to equity. One example is to integrate sociodemographic data into the analysis of workforce safety reports and incidents so leaders have a better understanding of who they are happening to, Ms. McGaffigan said. From there, leaders should focus on ingraining equity into core safety work. For example, by adding an equity lens when conducting root cause analyses, leaders can understand not only why an error occurred but if there are other interpersonal, institutional or structural factors that contributed to the harm.
4. Diagnostic harm. Diagnostic accuracy is another important area for leaders to watch. Staffing shortages, chaotic work environments and high levels of clinician stress and fatigue amid the pandemic may increase the risk for diagnostic errors, such as missed or delayed diagnoses, or diagnoses that are not effectively communicated to the patient. At present, no national data is available to quantify the pandemic's effect on diagnostic harm. However, diagnostic errors were already one of the most sizable care quality challenges hospitals were facing prior to the pandemic, Ms. McGaffigan told Becker's last year.
5. Healthcare-associated infections. A September 2021 CDC report found HAIs increased significantly in 2020 after years of steady decline. Pandemic-related challenges, including staffing shortages and high patient loads, have hindered hospitals' ability to follow standard infection control practices, CDC researchers said in the report. In response to the report, the Association for Professionals in Infection Control and Epidemiology urged healthcare facilities to assess their infection prevention programs and ensure they have the appropriate level of personnel and resources needed to protect patients and staff. Ms. Mobley of the Leapfrog Group said better surveillance and reporting of infections to the CDC and National Healthcare Safety Network is also needed in 2022 to help get back on track with this work.