By: John Rossheim, Monster Senior Contributing Writer
How healthcare staffing can make patient safety a top priority and help to reduce medical errors.
Even with legions of clinicians and healthcare executives laboring to improve patient safety, medical errors still cost tens of thousands of lives each year. Recent patient-safety initiatives have prevented countless errors. Yet as the American population ages and hospitals treat more acutely ill patients and those with complex medical problems, challenges remain.
What more can hospitals do to stanch the flood of medication errors, hospital infections and more unusual mistakes like wrong-site surgery? The good news is that by looking at the human-factors side of the patient-safety equation (i.e., company culture and health care recruitment) many institutions are making progress in guarding against medical errors by recruiting medical staff that will make safety their top priority.
Reducing Medical Errors Makes Sense Financially
More good news: With increased pressure on hospitals to cut costs such as avoidable readmissions of patients, there are now powerful financial incentives for investments in safety ranging from patient-monitoring technologies to training peer clinicians to critique each others’ safety performance.
“Insurers and the government are demanding transparency on quality metrics,” says Connie Curran, CEO of Best on Board, a nonprofit that provides governance education to healthcare boards. “If you don’t improve care quality, you’re not going to get paid.”
There’s also an increasing recognition that, in the long run, investments in patient safety pay for themselves. “High-quality care doesn’t cost more,” says Curran. “Errors cost; bed sores and infections cost.”
Creating a Culture of Patient Safety
In the 2000s, culture is seen as one of the most promising frontiers of patient safety. “Organizational culture is the key to establishing improvement methods and making them sustainable,” says Frank Federico, executive director for strategic partners at the Institute for Healthcare Improvement (IHI.)
A safety-oriented culture can begin with a tough battle: establishing checks and balances on traditional top-down authority in the medical profession. “We need the kind of culture where a nurse can tell a doctor, ‘You’re holding that sharp the wrong way,’ ” says Scott Geller, a professor and director of the Center for Applied Behavior Systems in the Department of Psychology at Virginia Tech.
Behavior-management techniques including training, goal-setting and feedback have been shown to increase clinicians’ use of basic safety procedures such as hand sanitization, often doubling the proportion of workers in compliance, according to a literature review coauthored by Geller.
Ongoing peer-to-peer training can help ensure that a safety culture permeates a hospital’s workforce. “Clinicians can use a simple interpersonal coaching process,” says Geller. “This is how astronauts train; they watch and coach each other.”
Employee Engagement Boosts Patient Safety
Company culture alone isn’t enough to hold off all potential medical errors; a successful patient-safety program must encompass both systems and people. Take medication, for example, where systems are available to match bar codes on individual doses with patient identification bracelets. “With bar coding for correct medication, if the system doesn’t fit into the workflow of nurses, they may use workarounds,” which are likely to increase the chance of errors, says Federico.
Hospitals must work hard to ensure that patient-safety initiatives are relevant to the conditions that bedside clinicians face daily. “Our research has found that problems most often identified by frontline workers don’t align with broad safety initiatives,” says Sara Singer, a professor at the Harvard School of Public Health. “National initiatives often assume wrongly that the necessary equipment is available and working, and that supplies are available. That’s why it’s important to find ways to allow workers’ voices to be heard.” The takeaway: employee engagement matters.
Hiring to Reduce Medical Errors and Improve Medical Care
Many hospitals have invested in staff whose sole job is to improve patient safety. Memorial Healthcare System in Broward Country, Fla., for example, has hired professionals for its quality department with expertise in culture change, infection control and medication safety, according to a case study by The Commonwealth Fund.
Retraining can help many hospital workers join a safety-oriented culture, and so can screening candidates for their willingness to adapt their work behavior to reduce risks to patients. “Some hospitals hire everybody based on fit with their safety culture,” says Singer. “These hospitals designate patient safety as a measurable outcome and align that goal with resources and worker incentives like promotions. We’ve also seen examples where hospitals have let go of a physician because of attitude and treatment of staff, after the hospital tried to help the physician change. You don’t have to do that very often to send a powerful message.”
In the 2010 health care hiring market, where demand in some occupations is slack and nurses are coming out of retirement to rejuvenate their savings, hospitals may have a unique opportunity. “When you’ve got a supply of nurses that outstrips demand -- as it does now in some areas -- it’s your chance to be picky about who you hire,” says Curran.