Getting the president of the United States to consider enacting your policy proposals is a major achievement. Having him actually implement them is an accomplishment that can change lives.
The patient safety movement reached that first milestone with a recent report by the President’s Council of Advisors on Science and Technology entitled, A Transformational Effort on Patient Safety. Whether advocates achieve the second, crucial goal remains very much an open question.
The PCAST casts a wide net, examining everything from nanotechnology to the public health workforce. It appears until now to have addressed patient safety only tangentially, when in 2014 it was a small part of a larger report on accelerating health system improvement through systems engineering. Many of that report’s almost decade-old recommendations – for example, “paying for volume rather than volume” and “sharing best practices” – unfortunately read as if they could have been written today.
The good news for patient safety advocates is that President Joe Biden has shown a genuine understanding of the issue. Thanks to a long-standing relationship with Joe Kiani, founder of Masimo Corp. and of the Patient Safety Movement Foundation, Biden keynoted PSMF meetings in 2015 and 2017. Kiani was appointed to the PCAST by Biden in 2021 and was co-lead, along with the chief scientific officer of Microsoft, of a special Working Group on Patient Safety that helped prepare the report.
“Not enough time has been focused on keeping bad things from happening,” then Vice-President Biden told PSMF in 2015, adding that it’s “absolutely within our wheelhouse to be able to change.”
“Able” and “willing,” however, aren’t the same thing. In a 2002 article describing how the news media turned patient safety into a priority, I noted that it was the highly publicized medical errors of the mid-1990s that launched the modern patient safety movement. Those incidents, in turn, led to the Institute of Medicine report, To Err is Human, which added to the real-people examples the shocking soundbite that up to 98,000 Americans were preventably killed in hospitals each year. The ensuing public uproar caused President Bill Clinton to summon industry executives and advocates to the White House in early 2000 and announce a series of executive actions. The report also spurred Congressional and state legislature responses.
In contrast, the carefully worded PCAST report garnered just a smattering of media coverage. Even when President Biden met with the PCAST in late September, his short public remarks beforehand singled out as priorities artificial intelligence and “expanding high-quality health care for every American.” The “major investment” in patient safety he touted was providing funding to fight deadly, drug-resistant bacteria.
The American Hospital Association did not respond to the report, perhaps because the closest the PCAST came to anything remotely accusatory was the modest complaint that “implementation of many…known solutions has lagged.” However, the association did announce an ad campaign urging Congress to protect high-quality care by rejecting hospital payment cuts triggered by “site neutral” reimbursement.
The PCAST report positions patient safety as “an urgent national public health issue,” noting that “harm from unsafe care occurs in all health care settings and affects all persons, from mothers and babies to seniors.” As an added fillip, the committee links patient safety both to health care workforce safety and to “substantial reductions in the total cost of health care.”
The report provides specific recommendations in four areas, carefully pointing out that none require Congressional action. The four areas are:
· Establish and maintain federal leadership for the improvement of patient safety as a national priority
· Ensure that patients receive evidence-based practices for preventing harm and addressing risks
· Partner with patients and reduce disparities in medical errors and adverse outcomes
· Accelerate research and deployment of practices, technologies and exemplar systems of safe care
Leah Binder, president of the Leapfrog Group, hailed the report in a statement that singled out two of the recommendations. The first one was to publicly report Never Events (medical errors that never should have happened) by individual facility. The second was a recommendation to establish a National Patient Safety Team.
A major barrier standing between recommendation and implementation is the patient safety movement’s paltry political power. At present, patient safety has little public awareness and no grassroots constituency. Hospitals, on the other hand, are an integral part of almost every Congressional district, have a largely positive public image and are facing tough financial pressures. The White House will think long and hard about taking any actions hospitals see as unreasonable.
PCAST recommendations that are sufficiently technical, vague (“supporting a just culture”) or similar to what’s already being done will likely be embraced. Most others, I suspect, will be quietly shunted aside.
Nonetheless, the PCAST report is an important document, solidly researched, and the prestige of its progenitors could possibly provide some political clout and momentum; for example, jump-starting the inactive Action Alliance to Advance Patient Safety announced by the administration last November.
The PCAST report represents one kind of milestone. Whether it prompts the major changes so urgently needed to bring “First, do no harm” closer to an everyday reality remains to be seen.
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