Publication Date: July 8, 2015
Jennifer Lenoci-Edwards, RN, MPH
Director, Patient Safety
Institute for Healthcare Improvement
Q: What has been your journey to IHI?
After I got my bachelor’s degree in psychology, I went to nursing school at the University of Alabama at Birmingham. At the end of the program I was lucky to do my practicum in the emergency department (ED), which I loved. Being an ED nurse was fast-paced and demanding, with new challenges all the time. I always say, my 15 years of ED nursing turned me into a jack of all trades and master of none.
Safety was always on my mind, from the very beginning. I will never forget my first significant patient safety mistake, a medication error. A patient presented having an ischemic stroke. Alabama is part of the “stroke belt,” and our ED had great evidence-based protocols, which I used many times over. But that day I set the drip rate too high and administered too much anticoagulant. I remember the phone call from the nurse on the unit, berating me for my error. Thankfully, they caught it and administered the antidote in time to prevent any further sequelae.
I was broken. I remember very clearly coming home that night and saying to my husband, “I don’t think I can go back.” I did go back, but not without great trepidation. Ironically, a week later while I was in triage, the same patient came through the ED, having another stroke. It was almost like an opportunity for a “re-do,” a gift, in a way. (She recovered, fortunately.)
But my mistake stayed with me. During all my years of nursing I was terrified of medication errors. I would say a prayer before work every day, “Please God, don’t let me hurt someone today.” There’s so much pressure in the emergency department; it’s so intense, it’s just too easy to miss something.
Ultimately, I decided to pursue my master’s in public health at Johns Hopkins, which led me to a position with the Maryland Department of Health and Hygiene, working to help develop and implement a state-wide immunization registry. Through this experience, I learned so much about health care systems, but, more importantly, I learned strategies to impact not just individual patients but whole communities.
In 2007, my family moved back to the Boston area and I returned to clinical nursing for a short time before a terrific opportunity emerged: the chance to work with Tejal Gandhi and Erin Graydon-Baker, two visionary safety leaders, at Partners Healthcare. In this role I became passionate about safety, especially in the ambulatory setting. I started to understand how to leverage human factors, culture, and systems to make health care settings safer for patients and staff.
This is also when I first encountered IHI because our Partners safety team had access to the IHI Open School. Through my courses and further reading, I was so impressed with IHI’s mission. It seemed bigger than I could conceive. The aspirations are so grand, I felt like, even if we make it part of the way, it’s so much better than where we are right now in safety. And I realized I want to be part of this movement!
In 2014, still at Partners, I transitioned to their patient-centered medical home program, where I worked with four wonderful teams to help them improve and drive toward the highest-level industry safety recognition (from the National Committee for Quality Assistance).
When I learned of the IHI Patient Safety Director position that became available, it was one of those moments you have in life… things just come together. During my IHI interviews, I came to know Trissa (Trissa Torres, IHI Senior Vice President). She had so much energy and optimism; it was so refreshing, and rare in health care. So many people are just trying to make it through the day, and there she was saying, “Let’s bring joy in work to these providers!” I could envision working so well with Trissa and others here at IHI.
Q: What are you focusing on in your work on patient safety at IHI?
I see several themes developing in IHI’s patient safety work. Our largest focus will be on expanding our safety perspective to include the whole continuum of care. We need to test and explore how to leverage the decades of work that brought IHI to the forefront of hospital safety and bring it into all ambulatory care settings: surgical centers, rehabilitation facilities, nursing homes, and so on.
There’s still a line at the hospital door, with unclear and often unsafe transitions between isolated systems and modalities. We need to bridge these gaps and focus on the full spectrum of care delivery to be successful.
Engaging patients is also vital, in patient safety and all of IHI’s areas of focus. We have to listen and learn what treatments matter to the patient, how we can we engage the patient in preventing safety events, where their awareness of risk is when they’re having a procedure done or taking their medication.
Supporting health care teams is another priority. We have to understand providers’ needs and give them things they can really use to make their clinic or unit safer. That means more than one-off quick fixes. They need a comprehensive safety plan that will help them improve their system reliability and enhance joy in work for providers and staff.
I hope to drive home the importance of culture, teamwork, and leadership engagement in all of our safety work. You can have the best team and the most motivated people driving the bus, but if you don’t have these three pieces it’s really hard to move the dial in safety.
Last, IHI needs to build more supportive partnerships with other groups in the safety arena. There are a lot of great organizations with the same end goal. Better “connectedness” and a cooperative approach will help us all move things along. It’s not about competition; it’s about coming together to pool expertise.
Q: What are some of the challenges you see ahead for patient safety?
The main challenge I see is the large and extremely complicated care delivery system. Even the smartest leaders struggle with how to navigate it and how to make the environment safer and more patient centered. Breaking down silos is essential. Everything we do in care delivery affects other parts of the machine; if you pull one lever, you impact 20 other levers. So the historic fragmentation and silos have serious negative consequences.
Spread is another big challenge: how to effectively spread reliable safety systems. A lot of known best practices for safety have been hard to get people to adopt continuously ― we can’t even get providers to wash their hands dependably. Overcoming the barriers to spread is a huge component of our safety work.
Q: What are you most excited about?
Personally, I’m very excited to be at IHI, working with committed safety faculty I’ve followed for years. I had the opportunity to join the IHI Patient Safety Executive Development Program right after I joined IHI, which gave me seven days to interact and brainstorm with safety leaders and such bright, committed attendees about their challenges and initiatives. I’m really looking forward to many more of such interactions.
And I’m excited to be able to put my knowledge and experience on the front lines to work by helping IHI motivate providers to think more broadly and proactively about safety and their role in improving safety. We can help the primary care physician, for example, understand how ordering the correct test means she can help prevent a patient’s heart attack, and the risks associated with hospital admission ― falls, medication errors, etc.
I’m not naïve; I know we have a long, hard road ahead in safety. But I’m glad to be on this journey.