A trip to the hospital is often a stressful experience. From a simple fear of needles to the uncertainty that accompanies waiting for test results or a diagnosis, our patients are understandably on edge when they first meet with nurses and physicians.
On the other hand, most people trust they are in the safest possible place when they enter the hospital. And often, they're surrounded by family and friends for support, helping them through a difficult time and sometimes even acting as advocates for their care.
However, not everyone has an advocate. And, research has shown that having an advocate can help eliminate medical errors and lead to safer care. More than a decade ago, the Institute of Medicine released a report that determined nearly 100,000 Americans die each year from preventable medical errors. And 15 years later, the patient safety challenge remains an urgent challenge. Last summer, the Senate Subcommittee on Primary Health and Aging heard testimony that suggested the harm to patients may be nearly four times greater than what IOM estimated in 1999. It is a poignant reminder of why healthcare professionals everywhere should think about how we can be advocates for safety not just when the calendar turns to the National Patient Safety Foundation's Patient Safety Awareness Week, but year round.
Now I want you to imagine a different care environment. One where trust has been replaced with suspicion and where patients are accompanied not by family members, but by police officers and guards. If the challenge of patient safety is serious for America's hospitals, it is mission critical for where my colleagues and I practice medicine: in America's prisons and jails.
As the Patient Safety Officer for the nation's largest provider of correctional health services, I serve a population that is disproportionately affected by chronic diseases and mental illness. Our patients are far more likely to have never seen a regular doctor or know their medical history. Our nurses and physicians face ongoing tension and stress as they strive to provide the best possible care while also navigating the needs of law enforcement and prison staff. The potential of violence must be factored in to every patient interaction.
But in this challenging environment, we've learned to rely on the patient safety practices that are recognized in hospitals across the country, with a slight twist: our clinical staff must always double as a patient advocate. For us, it is about empowering doctors and nurses to "stop the line" if there is a patient safety concern. Though easier said than done in our environment, it is nonetheless essential.
Just last month, one of our nurses saved a patient's life by acting as his advocate – the police brought a patient in with broken ribs and a lacerated spleen following a violent assault. An initial evaluation left the nurse uneasy and the patient's pulse was over 100 (he followed the "Rule of 100s," another patient safety practice). He refused to accept the patient. The police – understandably skeptical since the hospital had just discharged him – pushed back. Empowered by his training and supported by his supervisor, the nurse stood firm. The patient was returned to the ER, where he was diagnosed with a serious retroperitoneal bleed. He was rushed to the OR. Had he been booked at the jail, he would likely have died in his cell.
What are the lessons that healthcare professionals can learn from our unique challenges and experiences?
- Establish a speak up program. If your hospital doesn't have one, you need one. While it's ideal for a patient to be their own advocate, or to have a family member act as one, that is simply not always going to be the case. And creating an environment where not just the patient, but every staff member that has a patient interaction knows it is okay to speak up when necessary will set an invaluable tone.
- Change the culture, not the job description. Adding another task to an already jam-packed to-do list for nurses and doctors will not only be unappreciated, it will not work. Culture change is about teamwork, and creating an environment where one holds themselves and their colleagues accountable for following safe practices. It requires both autonomy and transparency.
- Double down on professionalism and respect. These two things are the "fuel" that allows culture change to happen. Dr. Lucian Leape, the founder of the modern patient safety movement, published two articles on the detrimental effect a lack of respect can have on patient safety. At Corizon Health, we took the step of establishing a Professionalism Policy, to allow us to constantly build upon our employee success expectations. Training is provided quarterly for new employees, and the policy includes expectations, examples of acceptable and unacceptable behavior, and most importantly, an accountability model with step-wise interventions to address unprofessional behavior, giving all employees the "tools" needed to be active participants in building the culture we need to ensure patient safety.
Rebekah Haggard, MD, CHCQM, CCHP is the Chief Quality Officer and VP of Quality and Patient Safety for Corizon Health, the leading provider of correctional healthcare services in the United States and the only correctional healthcare company that partners with the National Patient Safety Foundation.
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