NAHQ offers recommendations to preserve integrity of health care quality and patient safety systems

For too long, progress in preventing medication errors and other mistakes that compromise patient safety in healthcare facilities has been unacceptably slow and patients in the majority of U.S. hospitals may not be much safer today than they were 10 years ago, according to an editorial published in the Journal for Healthcare Quality (JHQ).

"In too many heath care organizations, clinicians are afraid to speak up to challenge colleagues who "short-cut important safety systems, who intimidate or retaliate against those less powerful, or who cannot demonstrate adequate expertise to provide safe care," says Cynthia Barnard, director of quality strategies at Chicago's Northwestern Memorial Hospital and author of the editorial.

Barnard noted it has been nearly 15 years since the Institute of Medicine reported that medical errors cause as many as 100,000 preventable deaths a year. Inadequate safety culture in healthcare organizations fails to protect those who could report quality and safety problems. "If our healthcare quality and safety data lack integrity, if our staffs work in fear, we will never be able to improve the care we provide, we will see another decade and half slip by without progress, and more patients will be harmed by medical errors," Barnard wrote.

Last year, Barnard led a National Association for Healthcare Quality (NAHQ) task force which authored a Call to Action and defined solutions for providers seeking to improve patient safety. The report urges healthcare organizations to establish accountability for the integrity of their quality and safety systems and respond aggressively to quality and safety concerns.

"A strong safety culture is essential for any health care organization to maintain effective quality monitoring processes and ultimately preserve the integrity of health care quality and patient safety systems," said Barnard. She added that many organizations have implemented technological changes to improve safety, such as electronic medical records and bar-coded medications, but it has become evident that technical change is not enough. Barnard further explained: "The toughest challenge seems to be creation of a truly safe culture of the healthcare provider enterprise. A safe culture welcomes reports of systems failures and near-miss events. It seeks insight into defects and harm. It engages staff, patients and families in partnership. It is a fundamental part of good medical practice. Increasingly it is also good business, especially as payment programs which tie reimbursements to quality measures are becoming more prevalent in the market."

In the Call to Action, NAHQ offers four specific recommendations which Barnard believes must be embraced at the highest levels of a health care provider organization. They are:

•Establish accountability for the integrity of quality and safety systems,

•Protect those who report quality and safety findings,

•Report quality and safety data accurately,

•Respond to quality and safety concerns with robust improvement.

Barnard described the NAHQ Call to Action as "an invitation to thoughtful leaders to hold a mirror to their own healthcare organizations and professional groups, to reflect honestly on threats and barriers to integrity and then to act responsibly."