Patient safety and quality are the most critically important elements of patient care. Safety and quality cannot just be given lip service, but must be measured and monitored to ensure that they improving or at least not declining. Many health institutions have regular monitoring of KPIs (key performance indicators) for patient safety and performance quality.
In fact, Medicare and Medicaid require that certain measures, such as specific mortality and readmission rates, are reported regularly and often made public. This is a bit like restaurant public health inspection ratings that can draw people in if they’re high or make them shy away—as from the plague—if they’re low.
First, do no harm
We have all heard the physicians’ guiding principle: “First, do no harm”. That’s not just a catchy phrase; it can be taken as a statement of action for people in the medical profession and it has measurable outcomes. Let’s break this guidance apart.
- First – “First” indicates that doing no harm—in other words, doing things right—has topmost importance in the physician’s job or in any job within the healthcare facility. The patient’s well being is and should be the healthcare facility’s priority.
- Do – Do means “act.” It is “morally reprehensible [although not illegal] for a physician to drive past the scene of an accident where his or her services could be lifesaving or to refuse to provide cardiopulmonary resuscitation to a fellow diner at a restaurant.” What other profession expects that action above and beyond the call of duty is actually part of the duty? Daily activities within the healthcare facility, and sometimes outside, require action to ensure patient safety.
- No – No means “zero.” Zero errors. Zero mistreatment. Zero bad patient outcomes from standing by and doing nothing. In other words, this is a “zero defect” statement.
- Harm – Anything causing bad outcomes for patients fits the adjective “harm”. Cutting out the wrong organ. Giving the patient a healthcare-associated infection (HAI). Prescribing incorrectly (including overprescribing opioids). Causing stress for the patient from an insensitive bedside manner. Sending a patient away without treatment because of lack of insurance or personal funds.
Prioritizing safety and quality
In my early career in manufacturing, our department manager prioritized efforts and outcomes in this order: Safety…Quality…Delivery…Cost. Knowing this order of priority was helpful in crisis situations and everyday decision-making. It was a very visible mode of operating and was reinforced by consistent top-down application. Customer and business needs often drove pressure to do things faster to reach quota or find ways to cut costs. But the order of priorities stood: safety and quality above everything else.
Of course, we weren’t the first to prioritize safety and quality. Toyota developed and now many companies use a flashing Andon light and siren that any person in the organization can trigger to stop the process for a safety or quality issue, even though the shutdown might delay product delivery and drive higher cost. This all-hands-on-deck signal brings knowledgeable folks together to solve the problem. Getting to root cause in real time is critical to avoid other problems with often amplified issues.
What manufacturing companies have learned is that allowing a safety incident to occur can cause bad quality, delays or reduced efficiencies, and increased costs. For example, OSHA (Occupational Safety and Health Administration) dollarizes lost-time safety incidents and can impose stiff penalties for unsafe working conditions. Running a process to meet quota when quality doesn’t meet spec is just foolish; ultimately the product will have to be remade, resulting in lower efficiency and higher costs.
When this misaligned thinking and acting occurs within the medical world similar bad outcomes result. A safety error can cause patient decline or death, resulting in a costly lawsuit. Pushing a not-yet-healthy patient out the door to free up a bed can lead to relapse and readmission, with low value-based insurance reimbursement. Putting safety and quality first is not only the right thing to do morally, but often the best thing to do for long-term financial success.
Creating a leadership position for patient safety and quality can be helpful. This director would have the authority and passion within the healthcare facility to help put these issues first when dealing with other leaders and board members and drive culture change across the organization.
Where is your Andon light?
You may not want another flashing Andon light and siren in your hospital, but you can do other things to instill the expectation and encourage the behavior that anyone in the organization can and should speak up when he or she thinks patient safety or quality is being compromised.
A relevant hospital situation might be a real-time emergency when instrument count after a surgery doesn’t match initial count. Speak up. It’s generally far better to take a few minutes to locate the missing instrument before closure instead of requiring a follow-up procedure for removal.
A physician may plan to release a patient after symptoms were treated in the ER, but root cause was not identified. If relapse is likely, another staff member may step in to act as patient advocate.
When nurses are having difficulty responding to patient call buttons in a timely manner because of understaffing, they should have the opportunity and encouragement to speak up. This might result in hiring more people, but it could also involve using operational excellence methods to improve efficiencies, freeing up staff time for more patient interaction.
How do you measure safety and quality in healthcare?
A saying is common in the quality world: “Without measurement, no improvement is possible.” How will you know if you’ve made improvements in patient safety and quality unless you measure your current and future performance?
You need to establish metrics, strategy, and tactics for improvement. You’re likely to start by creating a Patient Safety and Quality Committee that will review regulated measurement requirements, look at other facilities’ benchmarks, and assess internal needs based on areas of specialty. As with other operational excellence efforts, the team will prioritize problems or opportunities, determine root causes for issues, and put together an improvement plan.
What gets measured gets done. You’ll likely have metrics such as rate of medication errors, patient falls, hospital-acquired infection rate, catheter and bloodstream infections, time-based readmissions, and mortality rate.
With visible measurements, government or insurance action, patient selection (or de-selection), or simply motivation to be the best will help to drive the right behaviors to make improvements. Make sure you are putting a process for safety and quality management and metrics for measurement in place in your healthcare organization. Contact EON to get started with assessment and planning for improvements.