Commentary: Leadership is key to preventing healthcare harm

Efforts to improve patient safety have been underway for decades, but the scale of improvement has been limited. The result is that preventable harm in healthcare is still a leading cause of death in America. What's needed now is a shift from reactive piecemeal interventions to a coordinated system-wide effort. And key to that successful shift is the fuller engagement of healthcare leaders.

This shift is conceptual as well as tactical. It requires recognizing preventable harm as the public health crisis that it is — and tackling it on that basis. Once we view it through that lens, we can draw on America's extraordinary record of successful public health interventions to defeat it.

America has a long history of such interventions in combating specific diseases and conditions. Together they have produced an added 30 years of life expectancy — arguably our nation's greatest advancement of the 20th century.

Most encouraging recently, in the terms of patient safety, have been significant reductions in healthcare-associated infections. Key to those reductions has been the work of the Federal Steering Committee for the Prevention of Healthcare-Associated Infections.

Created in 2008, the Steering Committee brought together efforts of the U.S. Departments of Health and Human Services, Defense, Labor and Veterans Affairs. In 2009, it released a National Action Plan to Prevent Healthcare-Associated Infections to coordinate and guide efforts among agencies and stakeholders and to set specific reduction goals. The most recent progress report shows significant reductions, including a 50 percent drop in central line-associated bloodstream infections.

A fundamental lesson from improvement initiatives of the past decade is that most of them only succeed when leadership, culture, and patient engagement are fully aligned with the objective of greater safety. That's why leadership is so key, and why it's central to the new Call to Action that the National Patient Safety Foundation has created to combat preventable harm.

The Call to Action (available at consists of six priorities – each accompanied by a recommended action, a suggested tactic, and a set of key stakeholders. Leaders of healthcare organizations are key stakeholders for each of the six priorities.

The stakeholders collectively include those who set healthcare policy, deliver care, insure care, receive care, support patients, fund or research innovations, advocate innovations, and create partnerships. Together they form the basis for a coordinated public health response.

The six priorities – and the recommended actions for each – frame that response, as follows:

1. Define the problem and set national goals: Leaders and policy makers must establish preventable healthcare harm as a public health crisis and commit to reducing this harm across the care continuum;
2. Coordinate activities across multiple sectors to ensure widespread adoption and evaluation: Create centralized and coordinated national oversight of patient safety involving a broad array of stakeholders;
3. Inform, educate and empower the community: Partner with patients and families for the safest care;
4. Effectively measure and monitor progress at all levels: Create a common set of objective safety metrics to ensure widespread adoption, evaluation and accountability;
5. Identify causes and interventions that work: Ensure that leaders establish and sustain a culture of safety; provide sustainable funding for research in patient safety and implementation science; ensure that technology is safe and optimized to improve patient safety;
6. Educate and train: Support and educate the workforce.

Leadership is clearly essential to all six of these priorities, but leadership in each of them is still not enough. It must be aligned overall with culture and patient engagement.

Culture across the care continuum must make clear that patient safety is not simply a goal; it is core to the essence of healthcare delivery. What's the value of healthcare, if patient safety doesn't come first?

Patient engagement is similarly essential, because patients and their families know the most about their own circumstances. Only by incorporating that information will widespread adoption and evaluation of improvement initiatives be successful. Only by engaging patients in their care can the community be fully empowered.

The Call to Action is a blueprint for a coordinated public health response – one in which all Americans have a stake, as everyone is a potential patient. America's history with such responses provides a basis for hope. America's healthcare leaders can turn that hope into the prevention of harm on a major scale.

Preventing harm is essential, because the harm is avoidable and the toll it takes – in lives, in injuries to patients and caregivers alike, and in financial costs – is, therefore, unnecessary.

It's time to respond to the Call to Action. It's time to make preventable harm a thing of the past.

Dr. Tejal Gandhi is president and CEO of the National Patient Safety Foundation.


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