The statistics about preventable error are troubling. Each year…
- Between 44,000 and 98,000 people die in hospitals as the result of medical errors.
- Medication errors injure approximately 1.5 million people.
- Two million people develop an infection while in the hospital.
- Patient falls are among the most common occurrences reported in hospitals and are a leading cause of death in people ages 65 or older – a primary constituency of hospitals.
And the list goes on.
Health care organizations, because of their complexity and the severity of illnesses among the patients they treat, are full of patient safety concerns, and every health care organization that wants to provide high quality and efficient care, must carefully examine those concerns and address them.
Enhancing Safety through The National Patient Safety Goals
One of the leaders in the patient safety movement across this country is The Joint Commission, an independent, not-for-profit organization, which evaluates and accredits more than 15,000 health care organizations and programs in the United States through a set of comprehensive standards with which it assesses health care organization compliance.
Since 2003, The Joint Commission has required accredited organizations to comply with its National Patient Safety Goals (NPSGs). These goals address a variety of topics, including preventing infection, enhancing communication among health care providers, improving the safety of medication management, and reducing the risk of patient falls – just to name a few. “The purpose of the National Patient Safety Goal program is to focus the health care field on certain issues that clearly affect the safety of patients,” says Peter Angood, M.D., vice president and chief patient safety officer for The Joint Commission. “The requirements within each of the goals describe evidence-based and expert-consensus driven guidance to these issues.”
Each year, The Joint Commission publishes an updated set of goals. The goals are guided and prioritized by the Sentinel Event Advisory Group, a nationally-renowned, multidisciplinary group that works with The Joint Commission to undertake a systematic review of the medical literature and available health care databases to identify potential new goals and requirements. After extensive vetting, public commentary, and approval phases, the goals are made available to health care organizations and the public. The 2009 National Patient Safety Goals were released earlier this summer and are effective as of January 1, 2009. (link to box which lists the goals.)
“Initially, when we introduced the National Patient Safety Goals in 2003, the requirements addressed high-risk issues that were relatively easy issues to fix, such as removing high-concentration potassium chloride solutions from patient care units in order to prevent catastrophic medication mix-ups,” says Angood. “These goals helped organizations to quickly implement solutions, which eliminated some of the proverbial ‘low-hanging fruit’ safety risks. However as the National Patient Safety Goals program has evolved, the problems we address are getting more involved and the program’s guidance, therefore, somewhat more complicated. The goals have thus become more prescriptive in nature.” For example, improving communication among care providers is a complex issue addressed by National Patient Safety Goal 2. The goal requires organizations to address the verbal and telephone medication ordering process, eliminate dangerous abbreviations, improve the timeliness of critical test reporting, and enhance the handoff communication process to ensure the comprehensive exchange of critical information. Compliance with this goal – along with the other goals that apply to your organization - takes more than just a quick fix implemented by one department. Compliance efforts require a systems approach to safety (link to box on systems approach) and a commitment by organization leadership – including financial leadership - to be engaged in the compliance process. This includes demonstrating commitment by providing financial, equipment, and staff resources to improve and support compliance efforts.
The Financial Manager’s Role in National Patient Safety Goal Compliance
Historically, patient safety has been a topic for clinicians – nurses, physicians, pharmacists, and so forth. However, more and more health care institutions are taking an organizationwide view of safety and encouraging all members of the health care team – including the financial manager – to participate in safety efforts, including those that relate to the National Patient Safety Goals. “The financial manager is a pivotal resource for addressing safety issues; however traditionally this role has not participated heavily in safety initiatives,” says Angood. “In fact, one of the largest untapped resources within health care organizations is the CFO group. Safety lapses that lead to bad patient outcomes can significantly affect the financial bottom line of an organization and thus should be an issue on which the financial leadership of an organization focuses.”
Every time there is an unanticipated event in your organization that causes patient harm, it can increase the patient’s length of stay, the level of care required, and the overall consumption of resources. If a patient is in a health care facility longer than he or she should be, the patient also blocks access to the facility for other patients, thus impacting the organization’s throughput and volume capacities. Consequently, the increased costs and loss of revenue associated with medical errors can be a financial “double whammy” for health care organizations.
Is Improving Safety Really Cost Effective?
“In addition to the ethical reasons to pursue the best possible care for patients, the financial reasons are very compelling,” says Angood. Although the evidence that exists about the tie between improved safety and enhanced financial performance is mostly anecdotal or related to a specific set of issues, such as a comprehensive fall reduction program; and the cost benefit of safety may not always be apparent on a case-by-case basis; when you look at this issue in aggregate across patients, it is clear that reducing error can decrease patient care costs and increase revenue. “Any efforts that yield improved results are worth pursuing on several levels,” says Angood.
So How Can the Financial Manager Participate in Patient Safety Efforts?
One critical way to get involved with safety in your organization is to participate in the safety and quality committees that exist within your organization, such as those that relate to the National Patient Safety Goals. These committees discuss quality and safety issues and spearhead efforts to effectively address those issues. “By participating in quality and safety committees, financial managers can become more familiar with the safety risks inherent in their organization, the impact of those risks, and the efforts underway to address those risks,” says Angood. “In addition, they can become more involved with initiative design and the decision-making process in order to ensure that financial considerations are addressed, and that any road blocks are removed, before new initiatives get underway.” For example, before purchasing a computerized provider order entry system, it is critical to have an open dialogue between financial management, clinical management, safety management, information technology management, and front line staff to ensure all perspectives are heard and considered. Likewise, before purchasing hand hygiene stations to encourage better hand hygiene and reduce infection, a collaborative discussion between stakeholders – including financial management – is warranted.
It is important to keep an open mind when participating in safety and quality meetings. Although the traditional role of the financial manager has been to act as a “watchdog” for costs, a collaborative approach to safety management presents an opportunity to improve the care of patients while preserving and often enhancing the financial performance of the organization. Participating in a team-based approach to patient safety can help ensure comprehensive safety efforts, including effective compliance with the National Patient Safety Goals.