This opinion piece appears in this week's Modern Healthcare.
The enormous focus hospitals placed on preventing the spread of COVID-19 had little impact on the spread of other dangerous pathogens. Indeed, hospital-acquired infections surged during the pandemic, in some cases erasing a decade of progress preventing them. In other words, the focus on one viral infection appears to have distracted from the fight against other patient safety hazards. This is a bitter irony that likely led to countless deaths.
Post-pandemic, there has been a renewed determination in Washington and throughout the country that patient safety should never again take a back seat to other priorities. Given the high stakes, it is inadequate to protect patients against one danger while neglecting the others.
That is why there is so much emphasis today on making patient safety the top priority. And the efforts are paying off: New data show hospital-acquired infections are falling. Here are several forces converging to help accelerate progress in the coming year.
Public pressure
Leapfrog has learned from over two decades of experience how the public responds to patient safety issues. People tend to be surprisingly tolerant about mistakes hospitals make in the delivery of healthcare, but they will not forgive a lack of transparency about them. Any attempt to suppress it is met with a firestorm. We have never seen sentiment as high as it is today.
Federal financial incentives
Since shortly after the passage of the Affordable Care Act in 2009, the Centers for Medicare and Medicaid Services has been tying Medicare reimbursement to publicly reported safety metrics, and the agency continues to up the ante. In November, it proposed in its Measures Under Consideration list a tough new Patient Safety Structural Measure that could fundamentally transform how many hospitals do business. Among them, boards would have to commit to patient safety as a "core value" and devote 20% of their agendas to the subject.
A number of other recent federal initiatives will likely influence future action, including a sharply worded patient safety report to the White House from the President's Council of Advisors on Science and Technology and the Agency for Healthcare Research and Quality's National Action Alliance to Advance Patient and Workforce Safety.
Employer mandates
Most employers work with third parties like health plans and consultants to manage health benefits, but the Consolidated Appropriations Act of 2020 tightens employer accountability under the Employee Retirement Income Security Act. It means employers face regulators or lawsuits if they fail to act in employees' best interests-and they can't delegate that accountability to those third parties. They are directly on the hook regarding poor care and wasted dollars, which are hallmarks of patient safety events.
Workforce tension
Patient safety is both a symptom and a cause of the worker disengagement that is such a problem for healthcare providers. Leadership's neglect of patient safety issues forces workers to participate in a system of care that harms the patients they dedicated their careers to helping. That is deeply demoralizing, leading to burnout and turnover.
Health inequity
Leapfrog partnered with AARP and the Urban Institute in a study this year that found Black patients are much more likely to suffer preventable conditions like advanced pressure ulcers than white patients-even patients within the same hospital, with the same payer. Unlike disparities in health outcomes where social determinants play a role, preventable patient harm is primarily attributable to the delivery of care, which then raises important questions about equity in the treatment of patients. Hospital efforts to respond to regulatory and societal demands for equity will falter without a focus on addressing patient safety-and vice versa.
Technology
Technology will turbocharge the patient safety imperative. Two years ago, the Office of the National Coordinator for Health Information Technology issued certification guidelines that hinge on patient safety. Now CMS is proposing to penalize those found to be out of compliance. For instance, the guidelines stipulate that health systems should regularly test to ensure decision-support tools within electronic health records are accurate and up to date.
Additionally, advances in technology give us unprecedented capacity for advanced analysis of claims data, which helps payers identify the "never events": infections, errors and other events that harmed or killed patients and inflated costs.
Finally, technological innovations give healthcare providers new tools to combat safety problems. At Leapfrog's Annual Meeting this year, Dr. David Bates, Harvard's internationally known expert on the intersection of patient safety and technology, reviewed research and expert perspectives on new technologies that may help predict safety problems before patients are hurt or killed by them.
History may forgive pandemic-era lapses in patient safety, but it will harshly judge those who fail their patients post-pandemic. Healthcare leaders owe it to their patients-as well as their employees, their families, their country and their own personal legacy-to take action, and never let patient safety diminish as a priority again.
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Jim Flanigan, CAE
Executive Vice President
American Society for Clinical Laboratory Science (ASCLS)
11107 Sunset Hills Road, Suite 100 | Reston, VA 20190-5376
o: 571-748-3746 | m: 708-359-5721
jimf@ascls.org | @jimflanigancae
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