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Do shrinking resources at hospitals mean less patient safety?
Will the decade-long emphasis on quality help now?
For the past decade, patient safety and quality care — and all the assistant care policies and standards associated with quality initiatives — have been directed at improving efficiencies of both cost and process within health care institutions.
But how will these efforts to avoid preventable errors and improve health care quality fare during a historic downturn in the economy? According to Peter Angood, MD, senior advisor on patient safety at the National Quality Forum in Washington, DC, we don't yet know, because there is no data to tell providers yet. However, he also says there's "no doubt that many facilities are feeling the economic downturn."
"This patient safety movement is a little over a decade old — it's been this high focus — and in this past decade, we really haven't had an economic downturn to the level we're currently going through. So, in many ways, this is uncharted territory," he says.
But already there are reports that emergency department visits have increased, Angood says, although it is not known if that is due to seasonal fluctuation.
The NQF in early March released its "Safe Practices for Better Healthcare — 2009 Update."
"Those practices are tangible methods that organizations can utilize both for their systems and processes of care, as well as at the individual provider level to improve the safety and quality within their organizations," Angood says.
Angood suggests that "it is important for organizations to focus in on efficiencies of care, because we all recognize that there's a certain degree of inefficiency and waste in health care systems."
The NQF has another initiative, the National Priorities Partnership, that has "a specific focus area on the efficiencies of care," he adds.
"So, if you couple efficiencies with a focus on safety and a continued focus on quality, then organizations are going to have an improvement in their resource consumption, and they won't be getting into the difficulties of poor quality and poor safety, because they're cutting corners and cutting costs where they shouldn't be," Angood says.
Guarding against a decrease in safety
Angood says there may be staff layoffs, and — yes — hospitals and other providers are employing "all sorts of financial strategies" to help their organizations "save their money and increase their revenues."
However, he says, "Organizations, if they are smart, continue to emphasize the safety and quality processes in their facilities, because it's well recognized if you have complications or increased complications, then your resource consumption goes way up."
Treating complications of care provided in an institution often brings with it such circumstances as increased length of stay and decreased availability for other patients in that institution, he says.
"A lot of smart hospital leadership will be focused more on patient safety and quality to help with their resource management," Angood says.
Balancing needs and wants
Indeed, Doug Bonacum, patient safety officer at Kaiser Permanente in Oakland, CA, says that individuals in positions like his "may not spend enough time thinking about how they prioritize opportunities that they're going to go after."
Bonacum says that by that he means, "at the extreme," the patient safety officer could say every preventable event — regardless of how often it occurs or the harm it creates — ought to be "eradicated, because it's preventable. So that's what our patients would expect, that's what the public should expect, and that's what we should expect of ourselves."
"Ultimately, I think, to have that vision — it's a beautiful vision and an important one — clearly at Kaiser Permanente, we have statements like that about eliminating bloodstream infections, for example, eliminating pressure ulcers, for example, but I think what patient safety officers sort of fall short on is helping the organization, which has [patient safety] as the opportunity, but also [has] other demands and opportunities . . . and how to rationalize all that," Bonacum says.
In periods of shrinking resources, Bonacum says, it's people in positions like his where "the burden of proof" exists to "present that information in a way that their leadership can understand and act on, and in a way that also understands that there are resource constraints and other priorities that the organization is trying to go after."
But it is true, he said, that during periods over economic downturn, "the burden goes up."
Angood suggests that "one of the simplest, low-cost approaches" for an organization to rely on to achieve patient safety and quality care is "to have the leadership understand the importance of safety and quality in the processes of care."