My daughter just asked me what I was thankful for this Thanksgiving. As I reflected on the blessings in my family and personal life, I also thought about what I was grateful for in patient safety. While progress has been slower than any of us would want, we certainly have many things to count:
Patient- and family-centered care is getting long-overdue attention. About two years ago, nurses on one unit at the Johns Hopkins Children’s Center began conducting shift-change reports in patients’ rooms, rather than in the hallway, so that patients and family members have the chance to ask questions and get the most up-to-date information. More hospitals are including patients on committees. These are small changes, but they represent a larger acknowledgement of the importance of building care around patients’ needs and to seek their wisdom.
Clinicians are increasingly engaged in the work of patient safety. In the past they have largely stayed on the sidelines or have pushed back—often appropriately—against regulatory mandates, interventions or measures that are not informed by science. Yet clinicians did not step forward to take the lead. Now they are. Professional societies, physicians, researchers, nurses, want the science to be good, the measures to be wise, and the interventions flexible enough to fit into their local context. Over the last two weeks, I had calls with several professional societies planning safety programs. At Hopkins, more than 100 faculty members recently showed up at a meeting for those interested in conducting patient safety research.
We finally have a national success story for reducing patient harm. The CDC reported significant reductions in central line-associated bloodstream infections in ICU patients across the U.S., and most hospitals participating in a national project facilitated by Johns Hopkins researchers have seen similar improvement. With this model for change in place, we now need to focus on reducing other types of complications, such as harmful blood clots, that have eluded improvement thus far.
We are erasing the lines between us and working together. On the local level, physicians, nurses and other caregivers are finding solutions to hazards facing their patients. Collaboration is also evident on a larger scale. For the national bloodstream infection effort, state hospital associations, state health departments, quality improvement organizations, insurers and others have rallied together to provide the support needed to implement the program. No one group will be able to significantly improve care; it will take all of us, working together, sharing and learning.
Other disciplines are flocking to patient safety and enriching the science of improvement and measurement. Social scientists, human factors and systems engineers, and behavioral economists are advancing the science of improvement, helping to answer whether an intervention works and why. The field is maturing beyond one-size-fits-all tactics to more nuanced approaches in which different safety problems require different methods.
The field of patient safety is more tolerant of alternative views and respectful debate. All fields advance and decisions become wiser when we challenge each others’ assumptions, methods and results. For too long, the patient safety field had little tolerance for dissent about whether an intervention worked. To question it was to commit blasphemy. The field seems to be maturing, moving out of its tumultuous adolescence into adulthood.
The field is increasingly recognizing the importance of the head and the heart, of technical as well as the adaptive work of changing practices and changing culture. In a way, we are making health care more humane, permitting clinicians to acknowledge their shortcomings, make themselves vulnerable, and help heal each other. Hospitals not only report their infection rates but also share stories within their organizations about the patients who suffered preventable harm. On our unit-based safety teams, doctors and nurses review the results of surveys about the safety attitudes in their work area and discuss how they would like to work together. We ask them to visualize the behaviors they would exhibit if they had excellent teamwork, and then create a plan to make it so. We also focus a lot on training clinicians how to lead change, inspiring and influencing others. (But that is the topic for another blog. I need to bake a pie for dessert.)