Patricia Gaffigan, RN, senior advisor on patient and workforce safety for the Institute for Healthcare Improvement, voiced this question at an IHI conference in December. She said priorities are at risk of being reduced to a set of improvement projects — like fleeting goals, or something beholden to a start and end date.
When asked to describe the difference between safety as a priority and safety as a purpose, leaders from UCSF Health, M Health Fairview, Inova Health System and Jefferson Health told Becker’s that while priorities are important, they can deprioritize other plans, or even be deprioritized themselves.
“We, like all health systems, have a mission,” said Chapy Venkatesan, MD, chief quality and safety officer of Fairfax, Va.-based Inova. “The center component of our mission is world-class healthcare. So that is really our purpose. Safety is part of that purpose.”
How that purpose materializes throughout a health system or hospital varies.
Inova, which operates five hospitals, has conducted a system leader safety briefing every day since Jan. 7, 2020. The briefings are attended by the safety team, service line leaders, hospital executives, chief medical officers and Inova’s CEO, J. Stephen Jones, MD.
The takeaway here, Dr. Venkatesan said, is the unwavering commitment.
“Soon after Jan. 7, 2020, [was] the beginning of the COVID pandemic. We did not stop our system leader safety briefing. We kept going,” he said. “We had a record census two days ago in Inova Health System, and we didn’t say, ‘Well, you know what? We’re just going to kind of pause [the] safety briefing today. I know everybody’s busy.’ No, this is part of and integrated into our fabric and DNA.”
“I wouldn’t even say it’s part of the culture. It is the culture: that safety briefing,” he added.
At San Francisco-based UCSF Health, a strongly collaborative culture is the key to multiple successes, according to Amy Lu, MD, vice president and chief quality officer.
Over the past few years, most of its hospitals have received multiple “A” ratings from The Leapfrog Group and five stars from CMS. Vizient has named the system as a top performer for the past three years, and CMS measures show UCSF as having the lowest mortality rates among U.S. academic medical centers.
Also, since the pandemic, the system has noted a significant decrease in Clostridioides difficile infections, catheter-associated urinary tract infections and surgical site infections.
A moving target
Despite these wins, there is still a long way to go, according to Dr. Lu.
She cited a recent study, published in 2023 by The New England Journal of Medicine, that analyzed adverse events among hospitalized patients in 1984 New York, compared to those hospitalized in Massachusetts in 2018.
In 1984, there were 3.7 adverse events per 100 admissions, of which 28% were judged to have been caused by negligence and 16% led to death or permanent disability. In 2018, across 11 Massachusetts hospitals, the researchers found preventable adverse events in about 7% of all admissions, and “preventable adverse events categorized as serious, life-threatening or fatal were identified in approximately 1%.”
Over those three decades, healthcare-associated adverse events remained common and were found to be preventable about 25% of the time.
However, the number of tracked patient safety events and the rate of reporting these safety risks has increased — suggesting that, at least in some aspects, the healthcare industry has become safer since the 1980s.
Other research has shown slow improvements, and even declines, in hospital safety.
Abraham Jacob, MD, chief quality officer of Minneapolis-based M Health Fairview, said the lack of significant safety improvements is due to several factors. The most prominent, he said, is that hospitalized patients today are sicker, older, at higher risk of complications and altogether present more complex cases.
Take extracorporeal membrane oxygenation (ECMO) devices, for example. ECMO devices, which are life support machines that take over heart and lung function when organs fail, were first used in the mid- to late-20th century and have increasingly become commonplace in U.S. healthcare in the last 30 years. ECMOs present a high risk for pressure injuries, but without them, severe heart and lung conditions would have higher mortality rates.
“So we saved their life, [but the patient] would get counted in the safety registry as having a pressure injury,” Dr. Jacob said. “And so everyone feels badly about that, because it counts against your numbers, and it’s publicly reported. Well, the back story is that person’s life got saved, and we would have this patient who would have otherwise died 10 years ago.”
“We are saving more lives in terms of patients who used to die, but they’re also having complications in an effort to do that,” he said.
Uncharted territory
Inova’s Dr. Venkatesan compared measuring the success of patient safety to the success of marriage.
“You would never say a marriage is successful because there was an absence of divorce, right?” Using the same analogy, safety “is not simply the absence of harm,” he said.
Following the 25th anniversary of the landmark “To Err Is Human: Building a Safer Health System” report, several quality leaders told Becker’s they are leveraging high reliability organization principles, human factors engineering and quality improvement science.
These proactive strategies are needed to propel safety in healthcare, they said.
The traditional patient safety model is based on methods from the Industrial Age, Dr. Venkatesan said, such as retrospective analysis of harm events and digging for a root cause. But in an age of complex medicine, the healthcare industry might need to enshrine safety as a purpose.
“With all of the different headwinds that we face as health systems, as patients, as communities, that begs the question, is our traditional way of approaching patient safety the right way?” he said. “[I]s that what’s going to get us to where we want to be, or do we need to think about a new way?”