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
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
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
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.