Why would a well-respected, venerable health care organization adopt a soft and squishy approach—tracking disrespect and other forms of emotional harm—to monitor its performance?
In 2007, Beth Israel Deaconess Medical Center (BIDMC), a 672-bed health system affiliated with Harvard Medical School, adopted the audacious aim of eliminating all preventable harm by January 1, 2012. According to Kenneth Sands, MD, chief quality officer of BIDMC, the organization has not yet achieved perfection in this area, but the bold goal has catalyzed substantial advancement in patient safety at the organization.
Sands and colleagues described this courageous approach and their patient safety efforts at a presentation at the Institute for Healthcare Improvement Annual Forum in December. BIDMC patient safety experts have developed a process by which serious events, such as medical errors, are sifted from the “noise” of the thousands of reports received each year, such as “near miss” events. High-level statistics regarding these events are included on the organization’s performance dashboard, portions of which are shared publicly. Since launching the initiative, BIDMC has seen a 70 percent drop in serious harm events, despite improved reporting mechanisms that likely increased the number of harms reported.
According to Sands, the bulk of the improvement was due to several initiatives to decrease specific harms (for example, decreasing cardiac arrest in med/surg units). Quality and safety leaders realized that the harms that remained would require a broader approach.
At the same time, the organization had a parallel focus on improving the patient experience of care. Leaders recognized that patient safety and the patient experience were intricately linked (for example, disrespect often signaled a situation ripe for physical harm) and shifted their strategy regarding harm prevention.
“We merged the patient experience and the quality and safety committees. We now have a single group that reviews reports of possible harm—physical or emotional,” Sands explained. In addition, the organization created a dashboard for emotional harm similar to that for physical harm events and developed a process for identifying serious events.
According to Patricia Folcarelli, RN, PhD, senior director of patient safety at the medical center, a Respect Working Group reviews all complaints related to disrespect or incivility and uses a scoring methodology to rate severity and categorize events by type of harm. As with episodes of physical harm, the group conducts root cause analyses to better understand the upstream factors that created the situation in which the emotional harm occurred. According to Folcarelli, the group has found that the process “brings rigor” to the study of emotional harm, uncovers systems issues, and exposes “blind spots” that can then be addressed.
During my residency training in the early 90’s, I constantly worried about medical errors—due to a fault of mine or to a broken process that would expose patients to potential harm. I was grateful to see patient safety taken more seriously, after the release in 1999 of the seminal Institute of Medicine report, To Err Is Human.
I’m even more encouraged now to see that non-physical harms are being given their due “respect.” Among my friends and family members, the longest lasting harms I’ve observed have been the emotional ones. As a dear friend told me with still vehement anger almost two decades after such an event, “I felt like a case. Like I was wrong to be sad. He ignored my feelings and humanness.”
Virtually every one of us is a patient at some point in our lives. Why wait until then to fully appreciate the importance of respect to the patient experience, to patient safety, and to health outcomes? Placing emotional harms on a par with physical ones, and rigorously tracking both, is the step toward fixing the upstream events that put patients at risk.
Questions to consider: