Patient Safety Week 2012: Informing the Journey, Not Changing the Destination

Our destination appears clear—high-quality, safe, and continuously improving health and healthcare centered on, and in partnership with, the patient, the family, the public, and their community. So say the Affordable Care Act, CMS, IHI, WHO, Picker, NQF, IPFCC, Planetree, Joint Commission, IOM, MA Health Reform, NPSF, Health Care for All, ethical practice, extensive research, evidence from the field, and more. No doubt, it is also the destination we want for ourselves, our family, and friends.

In a recent article, The Cost of Satisfaction, Fenton and colleagues reported: “In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher over-all health care and prescription drug expenditures, and increased mortality.” These findings have received considerable media attention and triggered discussion in person, by email, on blogs, and for this author, more than a few urgent phone calls and requests. “What does it mean for patient- and family-centered care?” “My medical staff will be all over this today,” “Are our patient engagement initiatives not in the patient’s best interest?” “Jim, it doesn’t make sense.”

The healthcare community should be a learning community, asking questions, conducting research, performing tests of change, innovating and more. In the process, results may have us scratching our heads. Do we have the right questions, metrics, samples, or maybe, just maybe, are there mental models, things we believe to be true, that aren’t?

There will continue to be conflicting study findings out of strong teams in peer review journals; there are for the Fenton paper. Drawing on a few examples, Groene notes: “Research suggests that patient centeredness is associated with better compliance, patient satisfaction, better recovery and health outcomes, augmentation of tolerance for stress and pain levels, reduced readmission rates and better seeking of follow-up care…The evidence for the effectiveness of informing, educating and involving patients in their care is substantial.” In another article Bertakis and Azari found that “patient centered care is associated with decreased utilization of healthcare services and lower total annual charges.” Charmel and Frampton reported patient centered care associated with reduced length of stay, lower cost per case, decreased adverse events, higher employee retention rates, reduced operating costs, decreased malpractice claims, and increased market share. Just released, Gao and colleagues found “There exist statistically significant correlations between the value of ratings and physician experience, board certification, education, and malpractice claims, suggesting a positive correlation between online ratings and physician quality. However, the magnitude is small.”

As we celebrate Patient Safety Week, it is timely to reflect also on this theme and patient safety. Davis and colleagues note “patients can make valuable contributions to their health care safety. Little is known, however, about the factors that could affect patient participation in safety-related aspects of their health care management. Examining and understanding how patient involvement in safety-related behaviors can be conceptualized will allow greater insight into why patients may be more willing to participate in some behaviors more than others may.” From the WHO, Longtin and colleagues noted “Further research is essential to establish key determinants for the success of patient participation in reducing medical errors and in improving patient safety.” Daniels and colleagues just reported a study in which “Only 8 (2.5%) of the adverse events reported by families were also reported by health care providers.” Yes, we have things to learn together.

The Massachusetts community continues to lead and inform this journey. Weingart and colleagues reported “Most hospitalized patients participated in some aspects of their care. Participation was strongly associated with favorable judgments about hospital quality and reduced the risk of experiencing an adverse event.” Innovative initiatives of the Consumer Quality Council of Health Care For All contribute significantly. For example, the presence of and learning for patient and family advisory councils in all hospitals in the state, under statute, gets a “Wow” wherever I go (and a few “What? How did that happen?” too). In April, the Boston-based Lucian Leape Institute of the National Patient Safety Foundation will bring patients, family members, members of the public, clinicians, administrators, researchers, and policy makers (including representation from Health Care for All) together. Together, they will begin a year-long examination of existing knowledge about the implementation and impact of efforts to foster patient, family, and public engagement in patient safety improvement efforts.

Ending where we began, our destination is clear—high-quality, safe and continuously improving health and healthcare centered on, and in partnership with, the patient, the family, the public, and their community. Let us inform and adjust our journey, consider all research in a balanced fashion, and yes, be prepared to scratch our heads along the way.
-Jim Conway

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3 Responses to Patient Safety Week 2012: Informing the Journey, Not Changing the Destination

  1. Pingback: Holistic HealthCare | Planetree.org « The Good Word News

  2. Jim,

    Thank you for reminding us that research is a responsibility for all those organizations (and leaders) who would play an active and intelligent role in health care improvement: “The healthcare community should be a learning community, asking questions, conducting research, performing tests of change, innovating and more. In the process, results may have us scratching our heads. Do we have the right questions, metrics, samples, or maybe, just maybe, are there mental models, things we believe to be true, that aren’t?”

    Indeed, the spirit of inquiry you advocate is in the tradition of Kurt Lewin who several decades ago coined the term “action research” to describe a kind of practical, applied use of reflection and critical inquiry to guide our most important problem-solving efforts. We must be critical consumers of “data” from others’ studies. We must inform ourselves by regularly reviewing the findings from larger-scale, formal studies. However, at the end of the day, we must also study what we are doing in our own organization – action research. We must intelligently apply new practices or methods, learn from our experience, and adapt them as necessary to fit the unique circumstances in our organization.

    Therefore, we might ask: What are our specific problems? Do we have hypotheses concerning the nature of these problems or potentially effective solutions? Have we reviewed the literature or consulted with subject matter experts to enrich our thinking? How will we test our working hypotheses or apply proven practices that seem relevant to our organization?

    The real world, which Jim Conway and Kurt Lewin address, is seething with variation. Every organization is composed of unique combinations of people, structure, processes, and culture. Implementing change to improve safety and quality outcomes will never be reduced to mere cook-book solutions. Those who lead this change must also be action researchers.

    Bill Macaux, Ph.D. MBA
    Generativity LLC

  3. Hi Jim,
    Great post and I’m psyched to follow your blog and learn more about your work. Having a clear ‘destination’ is no small thing! If all stakeholders can be on board with it, incl nurses, docs, patient advocates, pharmaceutical companies, (and other vendor types), and lawyers. I believe we can get there.

    So for now, here’s to celebrating a vision of high-quality, safe, and continuously improving health and healthcare centered on, and in partnership with, the patient, the family, the public, and their community. I’d like to see something about equity in there too.

    Beth

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