Why It Matters
Despite substantial effort over the past 20 years, preventable harm in health care remains a major concern in the United States.
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Why We Must Keep Patients and Health Care Workers Safe

By IHI Multimedia Team | Monday, September 14, 2020
Why We Must Keep Patients and Health Care Workers Safe Photo by Noah Buscher | Unsplash

As with so many other industries, health care has been forced to remake itself amid the COVID-19 pandemic. For us, as co-chairs of the National Steering Committee for Patient Safety, the pandemic has helped to highlight the need to fix the persistent patient safety problems we’ve all been battling for decades.

We know that some health care leaders are still struggling with culture, leadership, and governance issues and that our health care workers are far from safe. Patients and families are getting more engaged as members of their health care teams, but they need a playbook. And we all need to learn more from the exemplar health care systems around the nation that are part of true learning systems.

Today, the National Steering Committee for Patient Safety, convened by IHI, has released Safer Together: A National Action Plan To Advance Patient Safety, which is the result of two years of work by 27 steering committee members who represent a diverse group of organizations and individuals, including health care systems, federal agencies, provider associations, accreditors, and patient advocates. Our goal is to provide health care system leaders with renewed momentum and clearer direction for reducing medical harm. We believe there’s an urgent need to re-energize and better coordinate the work in patient safety, build upon accomplishments, and move to accelerate progress in what the field has learned.

Especially relevant during the COVID-19 pandemic, the national action plan and a companion implementation resource guide provide the latest tactics, tools, and resources in a format ready for immediate implementation. These important new resources are built on four foundational areas: culture, leadership, and governance; patient and family engagement; workforce safety; and learning systems.

The steering committee has chosen these areas because excellence within each, and taken all together, have proven to be essential for everything health care seeks to achieve in safety. The shared aim of this first-of-its-kind coalition brings a renewed focus to ongoing harm to patients. In recent years, some members have observed a sense of complacency in the field. Other priorities have sometimes pushed patient safety to the back burner. 

However, the COVID-19 pandemic has reminded us that we cannot relax our commitment to patient and workforce safety. Many of the profound and unprecedented effects of the crisis on health care align with long-standing threats to patient safety, and the prevention strategies and fundamental requirements for both are similarly linked. For example, the use of personal protective equipment and other infection control precautions along with dramatic increases in telehealth are intended to prevent COVID-19 infections among health care workers and health care-associated infections among patients.

People and organizations throughout the health care system represent critical parts that must work in harmony to keep patients safe. We truly believe that we can save more lives by working in a collaborative way, and that by working together we can create a world where patients, and those who care for them, are truly free from harm.

Leaders must ensure their organizations attend to priorities we know are critical for safety: leadership commitment and organizational cultures with safety as a core value, governance and resource support for safety, and effective engagement with everyone who has a stake in the safety of health care — especially patients and their families.

As co-chairs of the National Steering Committee for Patient Safety, we are very proud of our new national action plan. During the COVID-19 pandemic, its recommendations couldn’t be timelier or more vital.

Jeffrey Brady, MD, MPH, is Director of the Center for Quality Improvement and Patient Safety at the US Agency for Healthcare Research and Quality. Tejal K. Gandhi, MD, MPH, CPPS, is Chief Safety and Transformation Officer at Press Ganey Associates and a Senior Fellow at the Institute for Healthcare Improvement.

Editor's note: Learn more about the National Action Plan to Advance Patient Safety and download a free Self-Assessment Tool and Implementation Resource Guide.

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