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Is the Patient Safety Movement running out of steam?

By Frank Federico | Thursday, March 7, 2013

Bob Wachter thinks so -- and he has a point.


Dr. Wachter recently penned a thoughtful piece arguing that the patient safety movement, for all its gains over the past couple decades, may be in danger of flickering out. He cites two major forces putting a brake on patient safety: physician burnout and strategic repositioning by delivery systems to deal with the Affordable Care Act, which he argues has displaced safety and quality improvement on the agenda of hospital boards.


These are serious concerns. As Wachter soberly notes, our work in patient safety is very far from over. And as it is currently Patient Safety Week, I thought I’d address Wachter’s post and give my thoughts about how we can keep the patient safety movement going strong over the coming decade.


Starting with burnout, I see two serious problems. The first is that we have not always sought to simplify processes as we have tried to make them safer. Some of our solutions are more complex than the problems we are trying to solve. We add more checks and balances rather than getting to the root of the problem, and this is a recipe for patient safety fatigue.


Another problem amplifying feelings of burnout is that our success has often been siloed – we’ve achieved improvement in one or two areas, but the successful practices or lessons learned there have not spread to other areas. As a result, we see improvement in the pilot area but not elsewhere. Many have not developed the robust infrastructure and mechanisms to ensure that there is spread, scale up and sustainability.  This gives the work of patient safety a Sisyphean feel, and in that context, it’s hard not to feel burned out.


For instance, a colleague recently told me that after years of hard work, the infrastructure she had put in place had slowly been weakened and, in some places, no longer existed because people had moved on or taken on other duties, because of changes in patient populations, and because they lacked mechanisms to sustain the improvement.


Jim Conway captures a similar feeling of being overwhelmed in a comment on Wachter’s blog, writing that many clinicians feel as though they are at the bottom of a waterfall with no hope the water will ever stop crashing down on their heads.


Wachter’s concern about the Accountable Care Act changing leadership priorities is likewise valid -- chief executives are concerned about how the proposed changes will impact their ability to function. Developing ACOs, medical homes, and Medicaid expansions will greatly affect their revenue streams, and so inevitably have become a focus.


So how do we respond to these worries about losing momentum?


Our responsibility to provide safe care and continually improve care processes is ongoing. But as we make our case, it is important to remember that safety is just one dimension of quality. The IOM's other dimensions -- care that is effective, equitable, timely, efficient, and patient-centered -- are critical as well. And none of them exist in isolation; indeed, they are inherently co-dependent. When we talk about patient safety, we should always be making the compelling case that it impacts all the dimensions of quality. The stakes are high, and we need to be clear about that.


We must also make ‘room’ for people to work on improving quality.  In a hospital I visited in Qatar, and in  hospitals in the US, physicians have dedicated time to work on an improvement project. This allows them to work on those things that they see as problems and getting in their way of providing the care that they believe their patients should receive.


Beginning on March 7, 2013, IHI will be hosting the 12th Patient Safety Executive Development class. I will be asking the participants for their comments on the future of the patient safety movement.  I’d love to hear your comments as well. 

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