Redefining Patient Safety: 6 Ways to Address Harm in Healthcare
By Dr. Tejal Gandhi
Safety is a public health issue that affects not only the well-being of our patients, but also the integrity of our entire industry. Over the years, we’ve made incredible strides in improving safety standards. Yet challenges remain. And, as we broaden our understanding of what constitutes “harm,” we begin to realize that emotional damage to patients can be just as impactful as the physical.
Despite my education and medical training, I know how helpless it can feel when you’re handed a life-altering diagnosis or comforting a loved one in pain. And it’s through the lens of these experiences that I urge our industry to accelerate progress in safety, as we relentlessly pursue zero harm.
Beyond the MD label, I am, of course, a human first. A patient, too. A mother, a daughter, a wife, a friend. I’ve personally dealt with the ups and downs of health and care. For example, several years ago, my father faced a life-threatening medical emergency. The care he received at a community hospital was extraordinary in many respects—dedicated physicians and nurses, a whole team committed to his recovery and well-being. Their work, without a shadow of a doubt, extended his life, and improved the quality of his life. I will forever be grateful for their compassion, support, and professionalism in handling his complex medical needs.
But this experience, with my father’s care, also gave me even deeper insights into the risks of healthcare. My father suffered from a series of adverse events—events that so many others often do as well. Surgical site infections (SSI). Central line-associated bloodstream infections (CLABSI). Deep vein thrombosis (DVT). Delays in critical test result treatments, readmission, and several near misses like medication reconciliation errors and handoff issues. These incidents underscore a disquieting reality: Even with a vigilant advocate at the bedside—someone well versed in all these dangers and the precautions needed to counter them—preventable harm still occurs.
It’s not just the inpatient setting, like in my father’s case. Both of my children have experienced medical errors in outpatient settings—an area where I started my career in patient safety as a researcher and where safety efforts have traditionally lagged.
With my daughter, a wrist injury was initially not diagnosed, only to reveal a fracture after persistent pain led us to a specialist. My son, undergoing allergy testing, was inadvertently given an extra dose of medication—a mistake that, thankfully, had no adverse consequences, but could have been catastrophic. These events not only caused physical discomfort in both my children, but they also eroded their trust in our medical system as well as demonstrated again that, despite my background, even I wasn’t able to keep the people I love most safe from harm.
What I’m describing is not unique to my family. So many people have similar stories—stories that highlight just how prevalent these medical errors are and reinforce the necessity of doubling down on our commitment to safety. In fact, in a survey of the general public, conducted when I led the National Patient Safety Foundation, 41% of respondents said they or a family member/close friend had experienced medical error.
How can we address safety challenges in healthcare?
In my decades of work in healthcare, as a physician and as a safety and quality leader, I’ve witnessed the remarkable evolution of our industry. We have, unquestionably, made significant, important progress in safety and high reliability. But the work is never done, and zero harm must always remain the North Star. To continue to accelerate that progress, we need a comprehensive approach to safety, anchored in a few key strategies.
Expand the definition of harm: A broader perspective and inclusive definition will help us prevent errors more effectively and holistically. Safety encompasses both physical and psychological or emotional harm—for patients and our workforce. Our workforce directly impacts patient safety: They must be kept safe and engaged to deliver the best outcomes for our patients. And as we strive to achieve our safety goals, we also must address inequities in harm, like those based on racial and ethnic disparities, socioeconomic status, and language or cultural barriers, among others.
Enhance safety across the continuum of care: Expand your focus from predominantly inpatient safety to include ambulatory and post-acute care settings. Errors occur across all stages of care, and most care is given outside the hospital. Our strategies must reflect this.
Promote a culture of safety: Foster an environment where all healthcare providers feel empowered to speak up and report errors and near misses without fear of retribution. Encourage transparency and continuous learning to continually improve your safety journey.
Implement systematic changes: Implement high reliability principles and practices to minimize the risk of harm. From communication and handoff procedures, to rounding for safety, to tiered huddles, to optimizing learning from events and near misses, adopting high reliability practices is key to consistent success.
Engage patients and families: Partner with patients and families to unlock valuable insights into areas for improvement and help ensure safety measures are centered around the patient. But it’s not enough to be safe; patients must also feel safe. Ask them about their perceptions of safety, across all healthcare settings, to identify and address experience gaps.
Leverage technology and data: Leverage advanced technologies and data analytics/artificial intelligence to identify patterns, anticipate risks, and implement preventative measures. Innovations like putting key data insights into the clinical workflow and real-time monitoring systems can play a crucial role in enhancing safety.
Addressing patient safety requires a coordinated effort from all of us, in all roles, and across the healthcare continuum. By broadening our understanding of harm, understanding the root causes of harm, implementing system-wide reforms, fostering a culture of safety, and using the data to inform decision-making, we can create a healthcare environment where patients feel safe, are safe, and their trust is maintained, or restored. But we must work together and act decisively—both to heal and offer hope.
Dr. Tejal Gandhi is Press Ganey’s Chief Safety & Transformation Officer and former CEO of the National Patient Safety Foundation.