More than a decade ago, a team of Johns Hopkins safety and quality scholars began meeting in a small office building along the Baltimore waterfront to discuss their research ideas. Physicians, nurses, a psychologist, economists, public health researchers and others would describe their goals, and then see how they could help one another to achieve(...)
Preventing Patient Harm
Health Care Shouldn’t Judge Itself by Flawed Tests
Posted by | Measurement of Safety and Quality, Preventing Patient HarmAs standardized exam scores increasingly define success for students, teachers and schools, parents worry about the dangers of “teaching to the test”—and of their children being judged by tests with low or unknown validity. We want our children to perform well on tests, of course, yet only if they measure something that students, patients and(...)
Change Day: An Overseas Concept for Patient Safety
Posted by | Organizational and Cultural Change, Preventing Patient HarmOften, when giving talks to health care professionals about the urgent need to improve patient safety and quality, I ask them to do an exercise. At the beginning of the talk, they write down “I will…” on a piece of paper. As the talk comes to a close, the audience is urged to complete that(...)
The Value of Safer Care
Posted by | Measurement of Safety and Quality, Preventing Patient HarmWhat is it worth to be treated in a hospital with a stellar patient safety record rather than one with lower performance? For a large majority of survey participants in a recent study by researchers from the Altarum Institute and Drexel University, the answer is quite a lot. Published online last month in the Journal of(...)
Small Wins Line the Path toward Zero Harm
Posted by | Organizational and Cultural Change, Preventing Patient HarmThe safety concerns that keep clinicians awake at night often aren't issues that you could fit onto a safety and quality dashboard. They aren't the kinds of things that feed metrics on the CMS Hospital Compare website or any of the other sources of publicly reported quality measures. They are intensely local, and no less(...)
New Ebola Training Modules Will Help Safeguard Patients, Providers, and the Public
Posted by | Designing Safer Systems, Preventing Patient HarmYour body is covered from head to toe in protective equipment, and it’s 115 degrees Fahrenheit inside your outfit. Your hands sweat under two pairs of gloves. An ill-fitting hood creeps down your forehead and nearly covers your eyes, but you cannot touch your head to shift it back up. To top it off, the(...)
Grandmothers Advancing Patient Safety
Posted by | Organizational and Cultural Change, Preventing Patient HarmLast Thursday, I made a presentation about patient safety to about 200 senior citizens at The Women’s Club of Chatham. My mother lives there, a picture-perfect town at the elbow of Cape Cod, with an old-fashioned main street that hosts a Fourth of July parade. For a while she had been asking me to give(...)
Free patient safety course returns in June
Posted by | Patient-Centered Care, Preventing Patient HarmFor the second year in a row, The Johns Hopkins University will lead a free online course, The Science of Safety in Healthcare, which begins June 2 and continues for five weeks. If you have ever wanted an introduction to patient safety concepts—or have colleagues with interest—this five-week course is a great opportunity. Transforming our(...)
Hospital-acquired infections: How do we reach zero?
Posted by | Organizational and Cultural Change, Preventing Patient HarmThis week, the U.S. Centers for Disease Control and Prevention issued two reports that are simultaneously scary and encouraging. First, the scary news: A national survey conducted in 2011 found that one in every 25 U.S. hospital patients experienced a healthcare-associated infection. That’s 648,000 patients with a combined 722,000 infections. About 75,000 of those patients(...)
A cure for ‘initiative fatigue’?
Posted by | Preventing Patient HarmFrontline caregivers across the United States—and in many other countries, no doubt—are bombarded by multiple quality improvement (QI) projects. A clinical unit might simultaneously be engaged in efforts to reduce readmissions, eliminate hospital-acquired infections and other complications, increase hand-hygiene compliance, improve performance on core measures, and enhance the patient experience. The demands brought by participating(...)