Have we made the U.S. healthcare system safer?

There is a lot of evidence that patients are safer in American hospitals and health systems since the publication of the report from the Institute of Medicine (now the National Academy of Medicine) in 2000, To Err is Human. We have significantly reduced harm in the form of iatrogenic infections, falls, retained foreign objects and many others. To see how GBMC has done, you can go to our public website: www.gbmc.org/quality.

But it is clear that we still have work to do. Other high-risk industries, like nuclear power, commercial aviation, or the French high-speed rail system have error rates in the less than 1 per million range. The U.S. healthcare system still has rates in the 1 per hundred to 1 per 10,000 range. We can and must get even safer.

Dr. Donald Berwick, the President Emeritus and Senior Fellow at the Institute for Healthcare Improvement (IHI) gave the keynote address at the 19th annual National Patient Safety Foundation Patient Safety Congress. He applauded those who have generated these real improvements but he pointed out that we still have a lot to do. He listed seven areas of concern that health care leaders should pay attention to in the effort to continue the progress of the patient safety movement. They are in Dr. Berwick’s words:

1. Displacement by other concerns: "As we go to boardrooms around the U.S. and hear what is being discussed, there are two topics: a changing reimbursement system and workforce morale. I personally believe there’s a strong connection between safety and cost reduction, but that conviction hasn’t been firmly established in 20 years."
2. Illusion of completeness: "There’s an illusion that we’ve worked on safety — 'here are our scores on central line infections, pressure ulcers and here’s what’s happening on medication reconciliation' — on to the next problem. The concept of safety as a box-checking enterprise, where we start and finish, is lethal to patients of the future."
3. Incentive theory: "Most of the workforce is already trying as hard as it can. Until we become scientists and give up the incentive-oriented approach to safety, we won’t make the systemic progress we have been calling on for years."
4. Metrics glut: "In pursuit of incentives, we’ve glutted ourselves with metrics. I think we are way beyond a level of toxicity. It's not just safety.  We have to go on a diet."
5. Separation of safety from quality: "When people say 'quality and safety,' what I hear is 'fruit and bananas.' Quality improvement is the big tent. It’s the enterprise of constant improvement to everything we care about. The quality of my car is dimensional. It has safety, durability and fuel economy and so does health care. I think reuniting our endeavors is crucial to our future. We don’t have the resources to waste on tribalism. We have to think systemically."
6. System literacy: "We need to become literate about the systemic properties that produce improvement."
7. Academic attacks: "I’m not sure why, but I deeply regret that academic students who position themselves outside the safety movement have all too often become critics. Until our academic brethren join in the progression of safety instead of positioning themselves as critics of the good-hearted work going on, they’ll be riding the breaks."
We at GBMC will stay focused on our vision phrase and every day we will work to measurably improve the patient’s health outcome and her care experience while driving out the waste and increasing the joy for those providing the care.

THANK YOU to our Information Technology colleagues!
Ten days ago, a major cyber-attack brought disruption to the health system in England forcing many hospitals and doctors’ offices to turn away patients and cancel appointments. People in affected areas were being advised to seek medical care only in emergencies. As a result, the United States and countries around the world sought to manage the spread of the "WannaCry" ransomware attack immediately.  That was also the case here at GBMC.

Dave Hynson, GBMC’s Chief Information Officer, and his team went to work immediately to diminish risk as much as possible by implementing the most current Microsoft security updates, and best practices as defined by our vendor partners. They also did an excellent job of informing the GBMC HealthCare user community by asking them to be vigilant with unknown or suspicious attachments.

All of the patching was accomplished by Monday (May 15) afternoon, including our Citrix servers and systems for which Microsoft made a patch available. As of today, we still ask GBMC staff to continue to be vigilant regarding all email and help to ensure that GBMC remains safe from a cyber-attack.

I want to thank Dave and his team for all their hard work in addressing the issues and keeping us on normal operations.