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How Patient Safety Factors into the Patient Experience Puzzle

Patient safety is an integral part of patient experience, and providers should systematically look to improving these measures.

- Patient safety needs to be at the core of providing a positive patient experience, which is why Peter Pronovost, MD, PhD, created a step-by-step method for ensuring his patients are safe from adverse harms and infections.

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It started when Pronovost, a critical care physician and Vice President of Patient Safety and Quality at Johns Hopkins Medicine, saw an adverse patient safety event that hit too close to home.

“An 18-month old girl died at my hospital from a catheter infection, and she looked hauntingly like my daughter,” Pronovost told PatientEnagementHIT.com. “After she died, her mother came to us and asked if this could happen to her other daughters, and if care is getting any better.”

Patient harms and infection rates at his hospital were high, Pronovost admitted, so he promised the mother that he and his team would work to improve that.

Hospital-acquired infections and patient safety events are also a nationwide issue, according to statistics from the Centers for Disease Control and Prevention (CDC). In 2011 (the most recent year for which CDC has raw data), nearly 722,000 patients suffered from an infection. Of those patients, 75,000 of them died from that infection.

Pronovost and his team at the Johns Hopkins Armstrong Institute for Patient Safety and Quality — where he serves as director— combed through the CDC guidelines for reducing infection rates and patient safety, streamlining the guide’s nearly 150 pages of suggestions into a five-point list.

First, the team worked on quick-fix improvements, such as ensuring the hospital was always fully supplied with necessary equipment, which improved their patient safety compliance to 75 percent. Next, the team focused on encouraging nurses to check in with doctors when doing catheters, which improved patient safety to 98 percent.

When Pronovost realized the effectiveness of his patient safety checklist, he decided it was important to scale across the nation. However, this effort was less about about demonstrating the team’s approach to improving patient safety and experience at Johns Hopkins and more about showing other practices the steps necessary for tackling their own unique patient experience challenges.

“We realized that change progresses at the speed of trust, and trust grows when you do things with rather than to people,” Pronovost said. “We said to other hospitals, ‘first, don’t use our checklist. Make your own and make it better.’ We knew that if we just handed people the Hopkins checklist, nobody would use it because it’s not theirs.”

Encouraging practices to develop their own patient safety checklists using those at Hopkins as a guide not only allowed practice leaders to target their individual problem areas but also allowed them to become proud of their new strategy and hold themselves accountable for following it.

Subsequently, Pronovost approached making patient safety checklists work for all patients and their unique needs based off of treatment type, preferences, and engagement level.

“Patients are at risk of dozens or hundreds of harms, and those harms vary by each diagnosis or procedure,” he said. “Every one of them needs a checklist and a community to solve. You can’t do that with paper checklists like we made.”

Pronovost created a digital tool, Doctella, that allows providers to work together to create a plan that will work on a case-by-case basis.

“We created this tool, which uses a platform that allows doctors or care teams to customize their checklist for individual procedures or even individual patients,” Pronovost explained. “It’s very easy to bring patients in to engage them, to make sure they get the right therapies.”

According to Pronovost, providers must engage the patient and serve her needs alongside their safety efforts to truly support the patient experience. Patient experience and patient safety go in tandem, he said, and are both the provider’s responsibility.

“For too long, we separated the quality of care and the experience of being cared for as two separate things,” he said. “In reality, I think most care providers said, ‘my job is to cure and those other things – well, they’re someone else’s job.’”

As much as patient safety and reducing infections are important to Pronovost, he says his job is only done if his patient has a positive experience.

“If a patient leaves our hospital and says we disrespected them, you better believe that’s a harm, and we have to do something about it,” he said.

Ultimately, his patient safety checklist tool – although aimed at reducing adverse patient safety events – seeks to also support the entire patient experience.

For the little girl and mother in Pronovost’s story, reduced infections could have been life-saving and led to altogether more positive experience for them both. For other patients, targeting avoidable adverse events could mean a more comfortable and attentive patient experience.

Going forward, Pronovost wants to see patient experience and safety become two sides of the same coin so that providers recognizethat poor experience as itself a harm.

“On a patient care level, I’d like to see that our caring is as big of a focus as our curing,” he concluded. “Just as we eliminated infections, I’d like to have every person leave this hospital saying that they were treated with respect and that they were heard.”

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