Becker's Clinical Quality & Infection Control

12 INFECTION CONTROL Dr. Don Berwick: 5 Big Missteps on the Patient Safety Journey By Heather Punke W hile the patient safety movement has made great strides since the late 1990s, the healthcare industry has veered off the path in a few ways during the journey, according to Don Berwick, MD. Dr. Berwick, the former CMS administrator and current senior fellow at the Institute for Healthcare Improvement, spoke to a crowd at the 19th Annual National Patient Safety Foun- dation Patient Safety Congress May 18. During the speech he highlighted some missteps in the approach that the patient safety community has taken throughout its improvement journey. Five of those mistakes are highlighted below. 1. Money has become more important than safety. Dr. Berwick noted most hospital board members and executives are increasingly more concerned about cost reduction and staying in the black than they are about patient safety. Indeed, quality and safety didn't even crack the top five concerns of hospital executives who participated in the Advisory Board Com- pany's 2017 Annual Health Care CEO Survey. 2. Believing the illusion that the industry has achieved patient safety. "We will never be done," Dr. Berwick said of the patient safe- ty movement. He called the concept of look- ing at safety improvement as a box-checking exercise with a defined ending point "lethal" to future patients. 3. inking incentives will improve safety. Nearly all healthcare workers come to work every day wanting to do well, Dr. Berwick said. at makes the incentive theory to patient safety improvement ineffective; as incentives come from the place of believing workers want to do something wrong and they need an incentive to do the right thing. "Until we … give up [the] incentive orienta- tion to safety, we won't make progress." 4. Too many metrics. Healthcare has "glut- ted [itself ] with metrics," Dr. Berwick said to applause from the audience. "We have got to go on a diet." He stressed the importance of identifying the most critical metrics and measuring just those, and not more. 5. Separating the quality and safety move- ments. At some point in the movement, quality and safety got placed in separate dimensions, which Dr. Berwick called "a mistake." He applauded the merger between the Institute for Healthcare Improvement and NPSF as a way of reuniting the two endeavors. "We don't have resources to waste on tribalism," he said. n Study: OR Doors Open 13.4 Times per Hour During Surgery, Raising Air Particulate Counts By Anuja Vaidya A study published in the American Journal of Infection Control examined operating room airflow, which can increase contamination risks during surgery. Over the span of one week, researchers measured air particulate counts in five-minute intervals and healthcare workers' movements. They also record- ed OR traffic, door openings, job title of the opener and the reason for opening. The researchers found that there were 13.4 door openings per hour during OR cases. The rate of door opening ranged from 0.19 to 0.28 per minute. Researchers recorded a total of 660 air measure- ments. The air particulate counts were 9,238 parti- cles at baseline and 14,292 particles during surgery. The air particulate counts increased by 13 percent when a door was open. "We observed numerous instances of verbal com- munication and equipment movement. Improving efficiency of communication and equipment can aid in reduction of traffic," study authors concluded. n IHI's Dr. Tejal Gandhi: 'We Have to Address Safety With a Total Systems Approach' By Heather Punke I n a recent interview with the In- stitute for Healthcare Improve- ment blog, Tejal Gandhi, MD, the new chief clinical and safety officer with IHI, said a total systems approach to patient safety is the future of the movement. Dr. Gandhi officially joined IHI June 1 after the National Patient Safety Foundation merged with the organization. She was previously president and CEO of NPSF. Here are three quotes from Dr. Gandhi from the IHI blog interview on a systems approach to patient safety. Stop thinking piece by piece: "We have to address safety with a total systems approach, as opposed to the piecemeal, initia- tive-by-initiative method common today — 'Let's do infections,' 'Let's do medication reconciliation,' 'Let's do surgical checklists.' We must address the foundational areas that are going to raise all boats," she said. Total systems is the future: "Shifting to a holistic, total systems approach to our safety mission, with a spotlight on leadership and culture, is the direction we're heading. And really using IHI's ex- pertise in the areas of leadership and culture, as well as in systems thinking in quality improvement and implementation, will facilitate putting ideas into practice." Approaching patient safety as a public health issue: "[I]t's recog- nition that we have to collaborate and, again, start from a total systems perspective. This is not a problem that individual hospitals working individually are going to solve. We need a national set of goals, metrics and interventions identified in a uni- fied national initiative. And we have models of successful national public health campaigns: think about seat belts or bicycle helmets." n

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