Improving patient safety: lessons from the trenches
As a former hospital chief clinical officer and chief operating officer, I have experienced power outages from storms and blizzards, hurricanes, flooding and bacterial outbreaks from contaminated water entering the hospital. Patients, families and entire communities could have been injured and affected for years afterward by these disruptions if not for the expertise and response of system engineers who proactively planned for disaster and worked quickly to mitigate the risks of these incidents.
But natural disasters are only the most obvious incidents that can impact the physical safety of everyone in the hospital. Contagious infections can spread quickly if not contained. Oxygen tanks in patient rooms pose fire risks. And the constant influx of supplies, materials and people coming in and out of a large, highly complex building, around the clock, day after day, multiplies the potential for incidents.
In short, hospitals can be dangerous places.
The numbers back this up. The Center for Disease Control reports that hospital acquired infections (HAIs) afflict up to 10% of hospitalized patients in the US every year. That is approximately 1.7 million HAIs, resulting in nearly 100,000 deaths and costing an estimated $20 million in healthcare costs annually.
If you lead a healthcare organization, chances are that you ask yourself every day, “What can we do to ensure patients are safe when in our care?” As you tackle the many issues that impact patient safety, your facilities are a good place to start.
Safety and risk reduction should be the absolute, number one priority for every hospital, and should dominate every strategy, operational and day-to-day management decision. That’s because treatment, procedures and surgeries that require a hospital stay are more successful when carried out in consideration of other, unseen safety issues. In fact, the hospital environment can play as large a role in the experience of patients and their families, not to mention outcomes and satisfaction, as expert treatment.
Expensive capital equipment must be maintained; the environment must be kept safe and clean; and staff need to be supported, trained and provided with proper tools and supplies. Personal protection equipment (PPE), patient lifting devices, gurneys, surgical tables, and air exchange and water treatment systems keep everyone—patients, families, staff, vendors—safe. Plans for fire safety and other disaster safety risks must be well composed, available, drilled by personnel and ready to function at all times.
Moreover, the facilities team must be educated on new standards for safety and readiness that emerge from accrediting bodies in response to changes in the environment as well as from new science.
Equipment and facilities, like healthcare itself, are becoming more technologically complex, requiring highly educated and sophisticated staff members who know how to operate, maintain and repair technical systems and equipment demands. Now, the building engineer’s tools include not only the wrench and the screwdriver, but the iPad, laptop, flexible scopes and electronic sensors.
Safety may have once been something of an afterthought or simply taken for granted, but it has begun to dominate leadership’s thinking and planning in terms of its impact on capital. Expenses around safety can erode margins as revenue shrinks and the profit structure of healthcare changes, but they are essential. Hospitals cannot put off investment in risk management and safety planning, including preventive maintenance of equipment and facilities, which now tend to require larger capacity air and water handling systems.
It’s important not to overlook compliance, as well. According to the American Hospital Association health systems, hospitals and PAC providers must comply with 629 discrete regulatory requirements across nine domains, costing these entities nearly $39 billion a year on administrative activities alone. On average, each institution has 59 full-time employees, over one quarter of which are doctors and nurses, dedicated to regulatory compliance.
When I worked at a hospital in California, we knew that on any given day, 186 different regulatory agencies could visit for a spontaneous check. Maintaining a safe environment wasn’t an option; it was a mandate every hour of every day.
Perhaps this is most evident when we think about the operating theater, which can be seen as the entire hospital ecosystem encapsulated.
Over the course of up to nine hours, a team of clinicians replace hearts, lungs, livers, kidneys, knees, hips and more. To ensure patient safety, the environment depends on systems that assure safe air exchange; wall gases; and backup power systems for machines, ventilators and pumps. Sterile tools on sterile trays and meds must be delivered, all with very specific protocols around process and delivery. Without proper and reliable systems and tools, the entire process stops and patient risk increases.
That reality is felt throughout the whole hospital. Facility management teams are devoted to what may seem to be mundane and obvious precautions, but are critically important, such as regularly scheduled, detailed inspections of boiler rooms and rooftops. Patient safety increases when they are performed at random times of day to observe, note and address irregularities that may be time specific. The payoff for this relatively modest investment in time? Increased patient safety and reduced patient risk.
Additional precautions include things as simple as handwashing and as complicated as multiple redundant backup systems for power, water and air handling. And while it is difficult to calculate the ROI of prevention, it’s easy to know how much your organization will have to spend should there be a major liability issue.
The break/fix mentality is not only inefficient, it’s dangerous, especially for things like oxygen tanks and backup generators. A burned-out lightbulb in a stairwell is a safety hazard if it impedes evacuation in an emergency and an outdated HEPA filter could jeopardize an entire hospital by allowing the spread of an airborne infectious agent. The automated monitoring of building systems, streamlined documentation of standard operating procedures and work orders, and other technology-driven leading practices can help keep facilities operating smoothly.
Capital must be prioritized to maintain facility infrastructure across the system. Think of it like this: you can spend $9 on a replacement belt for generators and compressors each year, or $500,000 to replace the equipment when it breaks down because of a broken belt. You may not know how much you should spend on prevention, but you can only guess how much you will spend if faced with a multimillion-dollar lawsuit.
With the wide range of factors that keep our healthcare landscape in a seemingly constant state of flux, prioritizing patient safety and reducing patient risk are safe bets when it comes to saving costs and, most importantly, lives.