AHRQ Views: Blog posts from AHRQ leaders
New Patient Safety Action Plan Underscores Need to Keep Patients and Healthcare Workers Safe
As with so many other industries, healthcare has been forced to remake itself in the wake of the COVID-19 pandemic. For us, as co-chairs of the National Steering Committee for Patient Safety, the pandemic helped to bring into sharp focus the need to fix the persistent patient safety problems that we’ve all been battling for decades.
We know that some of our healthcare leaders are still struggling with culture, leadership, and governance issues and that our healthcare workers are far from safe. Patients and families are getting more engaged as members of their healthcare teams, but they need a playbook. And we all need to learn more from the exemplars and true learning healthcare systems around the Nation.
Today, the National Steering Committee for Patient Safety released Safer Together: A National Action Plan To Advance Patient Safety, which is the result of 2 years of work by 27 steering committee members who represent a diverse group of organizations and individuals, including healthcare systems, Federal agencies, provider associations, accrediting organizations, and patient advocates. Our goal was to provide healthcare system leaders with renewed momentum and clearer direction for reducing medical harm.
Especially relevant during the COVID-19 pandemic, the national action plan and a companion implementation resource guide provide the latest implementation tactics, tools, and resources in a format that’s ready for immediate implementation. These important new resources are built on four foundational areas: culture, leadership, and governance; patient and family engagement; workforce safety; and learning systems.
The steering committee came together in 2018 to form a first-of-its-kind coalition with a shared aim to bring a renewed focus to the persistent problem of patient safety. Some members had observed a sense of complacency in the field and that other priorities were pushing patient safety to the back burner. For the steering committee, this prompted an urgent need to re-energize and better coordinate the work in patient safety, build upon accomplishments, and move to accelerate the pace of learning.
Many of the profound and unprecedented effects of the COVID-19 pandemic on healthcare align with long-standing threats to patient safety, and the prevention strategies and fundamental requirements for both are similarly linked. For example, the use of personal protective equipment and other infection control precautions, along with dramatic increases in telehealth, are intended to prevent COVID-19 infections among healthcare workers and healthcare-associated infections among patients.
Some observers have detected a sense of complacency that has allowed other priorities to push patient safety aside. People and organizations throughout the healthcare system represent critical components that must work in harmony in order to keep patients safe. We know that we can save more lives by working in a collaborative way, and that by working together we can create a world where patients and those who care for them are truly free from harm.
Today, we see even more clearly that leaders must ensure their organizations attend to priorities we know are critical for safety: leadership commitment and organizational cultures with safety as a core value, governance and resource support for safety, and effective engagement with everyone who has a stake in the safety of healthcare—especially patients and their families.
As co-chairs of the National Steering Committee for Patient Safety, we are very proud of our new national action plan. In the midst of a COVID pandemic, its recommendations couldn’t be more timely or more imperative.
Dr. Brady is Director of the Center for Quality Improvement and Patient Safety at the U.S. Agency for Healthcare Research and Quality. Dr. Gandhi is Chief Safety and Transformation Officer at Press Ganey Associates and a Senior Fellow at the Institute for Healthcare Improvement.