Call to Action: Preventable Health Care Harm Is a Public Health Crisis and Patient Safety Requires a Coordinated Public Health Response
Preventable harm in health care is a public health crisis, with estimates placing it as a leading cause of death in the United States.(1–4)
The National Patient Safety Foundation (NPSF) calls on health care leaders and policymakers to initiate a coordinated public health response(5,6) to improve patient safety and drive the collective work needed to ensure that patients and those who care for them are free from preventable harm (see figure 1). Such an approach has already contributed to significant reductions in health care–associated infections (HAIs).(7)
As outlined below, NPSF believes that a public health response — one that draws on the experience and expertise of public health professionals and public health organizations — will accelerate progress in the prevention of harm and establish the critical infrastructure needed to address this challenge across the US health care system consistently and sustainably.
Building on successful efforts to reduce HAIs(5,8–13) and taking advantage of critical lessons learned,(7) NPSF proposes the following public health framework to guide efforts. This evidence-based approach identifies effective, replicable interventions for effective propagation across the health care system.
NPSF urges greater collaboration among all stakeholders to address preventable health care harm and recommends widespread adoption of our public health framework to guide collective efforts (figure 1). Too often, efforts to blame individuals and organizations for preventable harm diverts attention and resources away from a more effective and sustainable collective response.
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Most care provided in the United States is high quality and safe, but technical and treatment advances also create new or expanded opportunities for unintentional, preventable harm to occur. As outlined in the National Patient Safety Foundation (NPSF) report Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err Is Human, errors and injuries that occur during care may cause significant mortality and morbidity, and can undermine patients’ quality of life.(14)
Efforts to improve patient safety have been ongoing for several decades, but the scale of improvement has been limited and inconsistent, with some organizations succeeding more than others. Some health care organizations have been able to successfully implement improvement strategies (e.g., checklists, medication barcoding, revamped care transitions), while others have been unable to introduce these same interventions or replicate the results.
Health care benefits from a dedicated workforce, but the systems and conditions that support safe care practice often fall short. When preventable harm occurs, a host of organizational factors often contributed to the outcome, many outside the control of any one person. A preoccupation with blame has distracted attention away from addressing the broader systemic issues at hand.
Meaningful advancement in patient safety requires a shift from reactive, piecemeal interventions occurring at individual organizations to a coordinated system-wide effort geared at providing safe care delivery across all aspects of care. Also needed is less finger-pointing and more collaboration. All health care stakeholders should work together to anticipate risk and uniformly apply system-wide safety processes across the care continuum (see figure 1). Critical, too, is support for health care professionals and other members of the workforce, as well as engagement of patients and families.(14) This reflects a key lesson of the past decade: Most improvement initiatives only succeed when leadership, culture, and patient engagement are fully aligned with the objective of greater safety.(14) A public health approach and our framework emphasize each of these essential components (see figures 1 and 2).
Using an integrated, evidence-based approach, public health seeks to ensure protection from — and prevention of — harm to the entire population. This approach, as outlined in our framework, identifies sources of preventable harm — in the case of patient safety, protection from harm related to health care — and then deploys coordinated prevention efforts (e.g., event surveillance and reporting, promotion of behavior change, and evidence-based interventions). It also would provide a structured method for integrating systems and the adoption of key patient safety and implementation science principles.
The advantages of a public health response are visible in work by the US Department of Health and Human Services and the Centers for Disease Control and Prevention to reduce health care–associated infections (HAIs). Established in 2008, the Federal Steering Committee for the Prevention of Health Care–Associated Infections united efforts of the US Departments of Health and Human Services, Labor, and Veterans Affairs. It released the National Action Plan to Prevent Health Care–Associated Infections in 2009 to coordinate and guide efforts among agencies and stakeholders towards the elimination of HAIs and to set specific reduction goals.(7) The most recent progress report documents significant reductions, including a 50 percent decrease in central line–associated bloodstream infections.(15)
Each of us will be patients during our lives. By extension, all members of society have a stake in improving the safety of our health care system. Similarly, successful implementation of a public health response to prevent health care harm requires coordination and partnership among all stakeholders, including government agencies, health care organizations, insurers, foundations, industry and other private sector organizations, as well as policymakers, patients and families, health care leaders, health professionals, and other members of the health care workforce.
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Call to Action
By initiating a public health response, health care leaders and policymakers can accelerate progress in patient safety and establish the infrastructure needed to ensure that patients and those who care for them are free from preventable harm across the health care system.
NPSF recommends widespread adoption of the public health framework described in figure 2 to guide collective efforts to address preventable health care harm.
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1 Institute of Medicine (IOM). Committee on Quality of Health Care in America; Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.
2 Centers for Disease Control and Prevention (CDC). Leading Causes of Death Website. National Center for Health Statistics. 2016. http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
3 James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 2013(Sep); 9(3):122–128. http://www.ncbi.nlm.nih.gov/pubmed/23860193
4 Makary M, Daniel M. Medical error - the third leading cause of death in the US. BMJ. 2016; 353:i2139. http://www.bmj.com/content/353/bmj.i2139
5 Card, AJ. Patient safety: this is public health. J Healthc Risk Manag. 2014; 34(1): 6–11. http://www.ncbi.nlm.nih.gov/pubmed/25070252
6 Noble DJ, Panesar SS, Pronovost PJ. A public health approach to patient safety reporting systems is urgently needed. J Patient Saf. 2011(Jun); 7(2):109–112. http://www.ncbi.nlm.nih.gov/pubmed/21577080
7 Office of Disease Prevention and Health Promotion (ODPHP). National Action Plan to Prevent Health Care–Associated Infections: Road Map to Elimination. nd. http://health.gov/hcq/prevent-hai.asp
8 Fielding JE, Teutsch S, Breslow L. A framework for public health in the United States. Public Health Reviews. 2010; 32(1):174–189. http://www.publichealthreviews.eu/show/f/25
9 Frieden, TR. A framework for public health action: the health impact pyramid. Am J Public Health. 2010; 100(4): 590–595. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2836340/
10 Jacobs JA, Jones E, Gabella BA, Spring B, Brownson RC. Tools for implementing an evidence-based approach in public health practice. Prev Chronic Dis. 2012; 9:11. http://www.cdc.gov/pcd/issues/2012/11_0324.htm
11 Centers for Disease Control and Prevention (CDC). A CDC Framework for Preventing Infectious Diseases: Sustaining the Essentials and Innovating for the Future. 2011. http://www.cdc.gov/oid/docs/ID-Framework.pdf
12 Office of Disease Prevention and Health Promotion (ODPHP). Healthy People 2020: Framework. nd. https://www.healthypeople.gov/sites/default/files/HP2020Framework.pdf
13 Srinivasan A. Patient safety is a public health issue [webcast]. 2016. National Patient Safety Foundation. http://www.npsf.org/?PLSOpenAccess
14 National Patient Safety Foundation. Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err is Human. National Patient Safety Foundation, Boston, MA; 2015. http://www.npsf.org/freefromharm
15 Centers for Disease Control and Prevention (CDC). 2014 National and State Healthcare-Associated Infections Progress Report. 2016. http://www.cdc.gov/hai/surveillance/progress-report/index.html
©2017 National Patient Safety Foundation, Boston, MA. Issued March 13, 2017.
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