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- Welcome everyone,
to the Becker's Healthcare podcast series.
I am Mariah Mohammed, writer
and moderator with Becker's Healthcare,
and I'm absolutely thrilled to have with me today Dr.
Elizabeth Mort, former senior vice president of Quality
and Safety at Mass General Hospital,
and current primary care physician
and associate professor of medicine
and healthcare policy at Harvard Medical School.
Doctor, it's very nice to have you on the podcast today.
How are you?
- I'm doing well, and thanks so much for having me,
Mariah. I am thrilled to be here.
- Yeah, of course. Um,
today we will be discussing patient safety.
So the first question I really wanted to ask you is, uh,
you were one of the senior authors on the safety
or in the Safe Care study published in January of 2023, uh,
in the NEJM.
Can you remind us of the headlines
and comment on the current state
of patient safety in the US now?
- Absolutely. And let, uh, I'll give you the headlines.
They're a bit sobering.
Um, and I wanna start by saying that despite the fact
that the headlines were sobering, I remain optimistic
that there is a way forward.
I do believe we need to raise the bar on performance.
The headline suggests we have room to move there,
and I also think we need to lower the bar on transparency
to promote more learning and improvement.
So the results of the study that you mentioned
that were published in January, 2023 in the New England
Journal, we looked at, uh, patients hospitalized in 11
Harvard affiliated Massachusetts hospitals.
And that was in 2018, so before the pandemic.
And we found that adverse events occurred in a quarter
of hospital admissions,
and our reviewers deemed that 23%
of those events were preventable.
Now, our results, uh, were not in isolation.
There were similar to results reported by the office
of the Inspector General.
And that study was looking at the same year,
the same performance year 2018 pre pandemic.
And that study was looking at just Medicare patients.
They found that a quarter of those patients experienced harm
during their hospital stays.
And physician reviewers in that study, judge that 43%
of the adverse events were preventable.
So a higher percentage
of preventable events in an older population.
And then the last study I'll just mention to describe sort
of the state of affairs is that CMS leaders reported
that in the early part of the pandemic,
so now we're looking at 2020, uh, nationally,
we had seen some slippage in our performance on common
safety indicators,
central line associated bloodstream infections,
catheter associated UTIs, et cetera.
So the news from 2018 and 2020 was sobering.
And these headlines, I would say the headlines were out
there, people listened, people in healthcare listened,
and they were a gut punch.
They were a gut punch for the industry.
And I think what's going on now is people
are digesting that.
They're, they're meeting those, uh, headlines with a range
of emotions from disappointment, frustration,
shame, and even anger.
But the good news is, is that people are moving on
and moving toward action.
- Yeah, absolutely. Thank you so much
for sharing that information.
Uh, are there any signs
that the healthcare industry is acting on the message?
- Absolutely. Um, there have been
so many exciting things happening this year.
Uh, the study that I mentioned came out in January of 2023,
and through the years, uh, through the months
of 2023, a lot's happened.
Perhaps one of the most exciting things is the President's
Council of Advisors on science and technology known as PCA.
They put out a report late summer on the transformational
effort on patient safety.
Very exciting activities.
Uh, CMS put out, uh,
some guidance on governance and leadership.
Um, governance and leadership arguably are
critical in getting an organization focused on doing the
right things, prioritizing the right things.
The Joint Commission has also
provided guidance on qapi, they call it, um,
which is really looking at how we organize our institutions
for constant improvement of care board to bedside.
And the joint commission's also put out incredibly important
information and guidance on equity, sustainability
and an increased focus on outcomes.
The A-H-A-A-H-R-Q are both putting out important efforts
to work on learning organizations, collaboratives
to advance performance.
And as we speak, uh, the CMS is, uh,
looking at measures under consideration.
Um, and there's an exciting measure being reviewed
to look at patient safety, uh, there as well.
Of course, organizations like IHI
and the National Patient Safety Foundation,
who've been leaders in this area for decades, continue
to sound, sound the alarm, and get the playbooks out
and support organizations in this important journey.
So there are many, many signs from high leverage,
influential organizations, many signs that
they hear the message, they get the message,
and there are playbooks out there, the challenges now, how
to get the playbooks in the right hands
and get everyone focused on organizing their agendas,
their goals, and getting the work done.
- That's wonderful. Thank you so much for,
you know, sharing that.
Um, kind of moving to recommendations for action.
Is there anything that you can think of
that the boards can do
- Well?
Absolutely. And some of the, uh, recommendations, uh,
coming out of these important national organizations
that I just mentioned are focused exactly at the boards.
Uh, boards vary tremendously in the type
of healthcare organization they are governing.
Um, however, they have incredible influence on
what the organization, uh, is doing,
how they're prioritizing, how they're investing,
what they're holding themselves accountable for.
Um, and you know, what they say, it starts at the top,
and that's true with, uh, patient safety.
So, um, the, the word out is certainly out there
that boards need to improve their, uh, competency,
their understanding of patient safety and quality.
Um, and there's lots of playbooks out there as well.
But basically, boards need to be educated.
We need to have the right people on the boards.
They need to understand what their job is, they need
to understand what the issues are.
And, um, once that happens, then they can be in a position
to help do their job, which is
to govern the organization's operations
and ensure that a healthcare organization is doing
what it's there to do,
which is give every single patient the opportunity
to have the best healthcare outcomes for them.
And that includes safe care.
So board activation, board education, board alignment
and board activity is really, really important.
It starts at the top.
- Yeah, I completely, completely agree.
It definitely starts at the top.
Um, but kind of moving down the ladder, what about c-Suite
and, uh, senior leaders?
- Yeah, so important, Mariah.
You know, I think we're do, we've heard a lot
of conversation over the years
and it's been, um, amplified this year, uh, for sure.
Uh, but I do think the board needs the c-suite, um,
to be at the ready, um, to help them understand
what the issues are for quality, for safety, for equity,
for disparities, all these important issues.
So the C-Suite really also needs to be activated as well,
and they are key key players.
So, you know, since the Institute of Medicine report in,
at the turn of the century, we've seen
functions develop in the C-suite, quality
and safety functions.
And that's great because now we have infrastructure,
we have reporting, we have all sorts
of improvement activities,
we have high reliability approaches, lots
of different tactics
and strategies, um, for advancing healthcare quality,
I think it's time that we sort
of play ball across the c-suite
and ensure that every single
c-suite leader understands what her
or his accountability is for quality and patient safety.
So the quality leader,
and sometimes there's a separate quality leader.
Sometimes the quality leader is embedded in a Chief Medical
officer role, or chief nursing officer role,
or chief operating officer role.
But each one of those c-suite leaders, including HR
and others, has an accountability
for improving patient safety that needs to be articulated.
That playbook needs to be written with, uh, more, uh,
intention and clarity.
And I think that will go a long way towards taking
what the board is expecting
and making sure that every single person
who has a responsibility for hiring, managing, delivering,
improving care, understands what he
or she can do to advance that.
I think we need to do some more work in the c-suite.
I think we need to do some more work in the
c-suite critical group.
- Yeah, definitely critical group.
And I know the C-suite is always, you know, uh, trying
to figure out what positions
and titles are needed at this very moment.
Um, if we can change, uh, the group a bit.
What about the frontline caregivers, doctors, apps, nurses,
technicians and staff, anyone
who really touches a PA patient, do you have any recommend,
uh, recommendations for action there?
- Oh, yes, of course.
Anybody who touches a patient has a role
and they have a job description, they were hired
to do something specific.
And I would like to see that in every single description
of a role, in every single job description, it's super clear
to that individual what their role is
in making care better and in their orientation
and in their management, and in their annual reviews
and reward that they are rewarded for advancing
not just their piece, but they understand
how their piece advances the goal
of the organization, right?
The goal of the organization is to deliver healthcare
and give every patient the opportunity
to get the best outcome for him or her.
Right. So, you know, there's a story that I, I mean,
I remember this story for, for, from decades ago,
but I've been telling it more lately
because I think a lot of, uh, younger folks have,
haven't heard the story,
but it's the story of President Kennedy's 1962 visit
to the NASA Space Center,
and he noticed sort
of an environmental health worker carrying a broom working
on, uh, his shift.
And, uh, president Kennedy interrupted his tour
and walked over to the man
and said, hi, I am Jack Kennedy, what are you doing?
And the individual said, well, Mr.
President, I'm helping put a man on the moon.
So that's more or less the story, uh, that people talk about
to illustrate how each individual has something to do,
and that individual understand how it relates
to the organization's mission.
So, you know, if we could get the board and the C-suite
and the managers organized around what the goal
of the organization is, what its mission, what its reason
for being is, and then understand each individual's role
and responsibility all the way down to those people
who touch the patient, a doctor an a PPA nurse,
a technician, a medical assistant,
and they understand, oh, we're here to improve outcomes
and my job is X, Y, or Z.
That's very doable.
And I think with that kind of an alignment
of every single person around, I mean,
could you imagine a better, a better mission
of an organization now, help help people get well,
to help people enjoy their lives.
And I think that's cultural work,
but it's also some, you know, nuts and bolts
and some tactical work
around job descriptions and management.
But I, I do think that it's all doable,
and I think we need to do some more work there as well.
And I think it will be work, work well worth doing.
- Yeah, absolutely. I completely agree there.
How important would you say culture is in this
entire situation? Does it really matter?
- Oh, gosh, yes. Mariah, you know,
culture's kind of the wraparound.
So you know, you go the board to the bedside
and then watch the wraparound milieu.
What is business as usual in that organization?
And when I visit organizations, I look for certain things
that are kind of cultural cues as to
how the organization is working.
You can watch things in the hallway,
you can watch things in the patient care unit
or the operating room, or the ambulatory center
or the waiting rooms, and you can kind of get a sense for
what the culture is like in the organization.
So, uh, it's a complicated topic,
and yet it's so foundational.
And, um, I think when it comes to culture,
and when it comes to patient safety,
what you wanna see in an organization is
that people are habitually doing those behaviors
that promote patient safety.
And clinically, I mean, these are the things
that we talk about with the National Patient Safety
Goals and the Joint Commission.
Are people doing timeout before procedures every time?
Are people using hand hygiene
every time they're supposed to?
Are they using closed loop communication?
So there are things that we know should be done
to promote patient safety.
And many of those things are habits.
And you can walk around and you can observe
and you can talk to people, and you can get a sense,
you can also measure safety culture.
They're tools out there now
that increasingly healthcare organizations are
using to help drive that.
But ultimately, it sort of circles back to what we started
with, which is governance.
What is the board really, um, governing and overseeing?
What is the c-suite talking about?
What is the c-suite doing?
How are they hiring folks, organizing, managing,
operating, rewarding?
So a, a culture is key. It's absolutely key.
And I believe that a focus on safety culture,
a focus on workforce safety, a focus on just culture.
Uh, these are words that have meaning.
We won't have the time to go into them,
but, um, without a focus on workforce safety,
without a focus on just culture, without a focus on reward
and recognition for the right things,
we won't get the most out of our organizations.
And that would be a shame if we don't start working on
that now and continuing to develop great models
for safe cultures in our organizations.
- Yeah, definitely. I completely understand
what you're talking about there.
Doctor, before I let you go, the last thing I wanted
to ask you very quickly is, do you have anything
to say about ai?
Where can these new tools kind
of help us in this entire situation?
- Well, AI for sure is giving everybody, um, great optimism.
And I think pretty much everyone has experienced AI in
healthcare in one way or another already.
And what I'm seeing is, uh, excitement
and even I would say joy.
Um, I went to a session where there was a debate
between an expert and an AI tool,
and they were trying to make a diagnosis
and, um, it was, it was so fun.
Uh, actually the expert, uh, got it first, uh,
but the AI tool was pretty good.
And, uh, that gives, I think, people great optimism that,
um, as smart as providers are, doctors, nurses, apps,
other folks, as much as we can keep in our brains,
I think there's gonna be an opportunity for those brains
to be complimented with AI tools that will, you know,
reduce diagnostic error potentially, and make care safer.
Another, another example that really has, uh,
I've seen people get so excited and we need excitement.
We need joy. We need people to wanna love to go to work
and feel like they're working at the top of their license.
And that's these ambient listening tools.
Um, ambient listening isn't a AI alone, um,
but AI can enhance it.
And essentially, you know, you can be in a, in a, in a,
in a room with a patient
and the AI listening tool can capture
what you're saying and write your note.
And I've seen, um, providers, I've never experienced
that personally, but I have friends who have,
and they are giddy with excitement about the promise
of these tools, which is, you know,
what we really wanna do is get people inspired to,
to join in healthcare organizations.
Um, I can't imagine sort of a, a, a more fulfilling mission,
um, and a career, uh, to join in healthcare
and be a caregiver.
Um, and I think AI gives us all promise that, uh,
it'll make it a little bit easier, uh,
to do the very best job that we can
and that our patients deserve.
So I'll just end, I wanna thank you very much
for having me today.
But, um, you know, despite the sobering news, um,
I'm optimistic that there is a way forward.
I think we need to raise the bar on performance
and lower the bar on transparency and get our C-suites
and our boards and all the way board to bedside,
everybody aligned and organized.
And I do believe the action in the past year from incredibly
important national high leverage organizations will help us
advance that, uh, work and with, uh, with some speed.
We shouldn't be competing on patient safety.
We're all in this together, and I'm optimistic
that we'll get there and we'll get there soon.
- Absolutely. I completely agree.
Thank you so much for those final thoughts, doctor.
There's definitely been an amazing
and informative discussion today.
So again, I wanna thank you so much
for coming on Becker's Healthcare,
and I look forward to connecting with you again soon.
- Thanks so much for having me.
- It's so important for leaders at the top of organizations
to keep learning, stay sharp, grow their networks
to help our audience better do this in a more simplified,
personalized, and meaningful way.
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