Top Ten List: Why Hospitals Need to Make Patient Protection 1stSM — and Why Patients and Families Need to Insist Upon It
Reason # 10 It’s not just a patient in that bed. It’s a sacred trust.
When a hospital assumes responsibility for a patient, the institution — and those who perform care within it — enter into a sacred trust with that patient and family. We have a right to expect that those responsible for our care will do everything they can to protect us.
No patient or family can ever be expected to know all the evidence‐based recommendations and best practices that should be followed for our safety, such as use of surgery check lists and “time outs” prior to an operation, computer physician order entry (CPOE), and rapid response teams available at the request of the patient and family. But we are entitled to expect that providers and professionals will know what these practices are, and that they will follow them. Patient safety literature constantly reminds us that most hospital errors could have been prevented if a few simple steps had been taken, like washing hands, or reading the chart before administering medication, or confirming that it was the right patient for the scheduled surgery.
True champions of patient safety in the hospital setting ask, “Is this how I would like my father or mother, my sister or brother, my wife or husband, my son or daughter, to be treated?”
Healthcare providers that make Patient Protection 1stSM are driven by the realization that the most important person in the world is the patient before them right now.
Reason # 9 Life‐threatening hospital‐acquired infections never send a calling card before they show up in a patient’s room. But patients and families will always know after they’ve arrived.
Hospital‐acquired infections claim at least 100,000 lives in the United States and Canada every year, and leave a million more patients sicker than they were at admission.
It takes constantly vigilant, hygiene‐proactive care providers, and a strongly enforced safety culture, to make the arrival of these silent killers unwelcome.
Healthcare providers that make Patient Protection 1stSM anticipate infections before they arrive and take effective steps to prevent them at every level, from hospital maintenance and cleaning to post‐surgery care.
Reason # 8 You’re a healthcare professional who has a problem remembering to perform hand hygiene before and after patient contact. Really?
Studies by the Centers for Disease Control (CDC) and World Health Organization (WHO) have consistently shown hand washing by healthcare workers to be one of the most effective strategies in combating infections in the hospital setting. Yet compliance with this vital patient safety tool is seen by experts as “disappointingly low” and far from where it needs to be in most hospitals. One major U.S. study reported hand hygiene compliance in hospitals to be 36 percent on average.
For years, leading healthcare authorities have been using multi‐million dollar awareness campaigns — with posters, conferences and learned papers — to encourage hand washing compliance. The message is being sent, but it’s not being received well enough among some healthcare providers.
Healthcare providers that make Patient Protection 1stSM ensure that hand washing practices are rigorously followed without exception. And they don’t need pushing, prodding and pleading to do it.
Reason # 7 I’m more than just a hospital number.
Beneath that hospital gown and mass of tubes lies a fully unique human being whose life has been a precious gift. That “patient” is a real person who touches the lives of countless others. Her or she has an intrinsic value that makes them worthy of being treated with dignity and respect, regardless of age, socio‐economic status or medical condition.
Yet patients and families who have experienced harm frequently report that they were treated as an inconvenience or worse, and not as if they really mattered. Age is often a factor in these situations. Many families claim that their loved one’s concerns, or chances of recovery, were not taken seriously or that they seemed to be written off altogether. A sense of abandonment is not uncommon among the emotional harm that patients and families voice. Practitioners of care need to see beyond stereotypes and guard against the just‐another‐patient syndrome.
Patients, and their families where that is appropriate, need to be at the center of care decision‐making. We are entitled to know that we have the right to refuse treatment or care and that when care is delivered, such as tests and medication, it is based on patient/family consent following full disclosure of the risks and benefits.
Healthcare providers that make Patient Protection 1stSM never fail to respect the inherent uniqueness of the person they are caring for. They take steps to embed that recognition in their culture and in the system of care that is delivered to every patient of every age.
Reason # 6 Compassion, kindness and respect can be as potent as any drug. When they are missing, the outcome can be as dangerous as a disease.
Research has shown that values like compassion and kindness have a positive effect on patient outcomes. And when these values are ignored by members of the care team, patients often feel a sense of abandonment and discouragement that can presage significant downturns in their condition.
Compassion, kindness and respect are part of what we call The Lorraine Finlay Healing Healthcare VirtuesSM .They are what patients and families have time and again reported to be the values that are paramount in fostering safe care and emotional comfort. They are named after the mother of The Center’s founder, who demonstrated these virtues in the care she delivered as a nurse for many decades beginning in World War II. Unfortunately, these same virtues were glaringly absent when she needed them, with horrific consequences that resulted in an epidemic of avoidable medical harm at two hospitals.
These virtues come in many forms, from showing respect to patients and families by incorporating policies that see healthcare professionals knock on the patient’s door before entering, introduce themselves by name and make eye contact in the process, and explain their purpose in being there. It also refers to respect for the patient’s privacy and dignity, including the type of gowns and clothing used in the hospital setting. When healthcare professionals need to have a discussion with the patient and/or family, it should occur on the same physical level, maximizing eye contact and using clear, but non‐threatening and respectful, language.
Healthcare providers that make Patient Protection 1stSM recognize these virtues as being as essential to the care and healing of a patient as a sterile bandage after surgery. They strive to integrate these healing virtues throughout the entire care paradigm and take corrective actions when they have been compromised.
Reason # 5 Don’t call families “visitors.” We are full partners in the care team.
While it is the patient who is receiving care, the reality is that often their family is hospitalized, too. Patients want and need the support of family members. Research has shown that family involvement is a key factor in creating more positive outcomes for patients. Family members are an integral part of the care team. As experts on our loved ones, we are in a unique position to sense changes in the patient’s condition and to bring concerns forward in a timely manner.
Hospital policies and practices need to reinforce principles of patient‐ and family‐centered care at every stage from admission through discharge. They need to embrace the role of families, be prepared to share information with them, collaborate with them in developing and following a plan of care, and support them fully in their hospital participation.
Providers that are truly patient‐ and family‐centered know that the hospitalization of a loved one can be among the most traumatizing and stressful periods ever experienced by a family. The health of family members themselves can be placed at risk from exhaustion, work strains and financial challenges that arise when a loved one is suddenly hospitalized.
Flexible access hours that allow caregiving families to be with their loved ones when they want and need to be is an important starting point in providing family support. But little things, like a reassuring gesture, a friendly smile, finding a comfortable chair for someone who has been standing for a while — these can make a huge difference in giving families the support we need to help a loved one through their hospital journey.
Healthcare providers that make Patient Protection 1stSM understand the critical role families play in the care and recovery process. They walk the talk when it comes to principles of patient‐ and family‐centered care, and encourage the full participation of families in rounds, during nursing shift changes and in every step of care delivery.
Reason # 4 Openness and transparency are signs of a healthy hospital culture. They are also indispensable to patient health.
Patients are ethically and legally entitled to information about their health and the risks they face. This includes the right to give, or withhold, consent for treatment, tests and medication based on full disclosure of the facts and risks involved. This also includes timely access to patient medical records. Ensuring that patients are fully informed, and are treated as full partners in their care, enhances their sense of engagement and adherence to treatment regimens.
A second branch of disclosure in the hospital setting involves steps to ensure that patients and families are aware of the risk of breakdowns in patient safety procedures. That discussion, and information about the reality of hospital errors, needs to take place in an orientation process at admission. Patients and families need to be encouraged to be watchful, to ask questions and to take steps to make any concerns or complaints fully known.
There needs to be a legitimate 24/7 process for reporting and addressing concerns and complaints in a good faith manner, and the process to set any formal review or redress in motion needs to be clearly spelled out and consistently available in a variety of forms to patients and families. This is an essential way for a provider to acknowledge and give force to their duty to protect patients from harm, including emotional harm, and to deal with it when it occurs.
Healthcare providers that make Patient Protection 1stSM know that they have a duty of candor to all patients and families in ensuring they have the information they need to engage in their care, to protect themselves from harm and to act when it occurs.
Reason # 3 A complaint is not a declaration of war and should not be treated that way by the hospital. It is an opportunity to learn and to demonstrate the best values that guide healthcare providers.
Evidence suggests that few patients actually make a formal complaint and are reluctant to do so even if they feel justified. But when a complaint is made, it is with the expectation that it will be dealt with fairly, objectively and in good faith. Research also shows that complaints can be predictors of harm to come and therefore provide clinical teams with a red flag that allows them to heighten vigilance and patient care practices.
Unfortunately, in many cases patients and families report that the mission of provider complaint units (sometimes called patient relations offices or patient and family experience departments) is to mollify patients or to avoid bad publicity or litigation rather than dealing with the effects of medical errors or harm on the patient and family. Complaint processes can also be cumbersome, opaque and are typically inaccessible during evenings, weekends and holidays, when patients and families often need access to them.
As a result, the experience of many patients who have filed complaints has not been good. Indeed, research shows that often patients and families were more troubled by the way a complaint was handled, and the emotional harm that resulted, than by the underlying medical error that led to the complaint being initiated.
Dealing with complaints on the basis of a hospital’s core values of honesty, compassion, openness and kindness, and its professional commitment to do no harm, generally finds a positive response on the part of patients and families. They are not seeking to punish or embarrass if treated openly and in good faith. Rather, they are seeking answers, an indication that learning has occurred and that an apology will be offered for the harm that has been done.
Healthcare providers that make Patient Protection 1stSM deal honestly and openly with complaints and embrace the opportunities for learning and improvement they provide.
Reason # 2 If you harm me, you owe me an apology — and a lot of help and compassion to help me, and my family, heal.
To err is human; to cover up is not. The willingness of hospitals and clinicians to take ownership of an error, and to attempt to heal all those affected by it, is an irrefutable obligation of every provider of care. But in too many patient and family experiences, hospitals seek to evade accountability for the harm they have caused.
As the highly respected Agency for Healthcare Research and Quality (U.S. Department of Health and Human Services) notes,
When a patient is a victim of an error, hospitals have traditionally followed a ‘deny‐and‐defend’ strategy, providing limited information to the patient and family and avoiding admissions of fault. This response has been criticized for its lack of patient‐centeredness, and in response, some institutions have begun to implement ‘communication‐and‐response’ strategies that emphasize early disclosure of adverse events and a more proactive approach to achieving an amicable resolution.
A healing culture of compassion and apology needs to replace the deny‐and‐defend mentality. It is no less a professional obligation of healthcare providers to administer emotional healing to patients (if they have survived) and families in the face of a medical error than it is for a doctor or nurse to perform first aid at a crash site.
Research has shown that in many cases, all that a patient or family is looking for in the aftermath of harm is an explanation for what occurred and an apology. A genuine and heartfelt apology will frequently offset the risk of litigation. An apology is a healing tool. It facilitates closure and reaffirms a provider’s commitment to the virtues of compassion and respect which patient safety literature consistently shows is so important to patients and families who have suffered harm. It is also a demonstration that the healthcare provider and those involved in the error have learned from it and have taken steps to minimize the risk of it happening again. This, too, is vital to the needs and expectations of those who have suffered harm.
But apologies must be done in the right way, at the right time, and with the right participants in the process. Too many healthcare providers overlook these components. In many circumstances, an apology should be accompanied by some tangible form of financial atonement, however modest, such as a reimbursement of out‐of‐pocket expenses, like hospital parking costs.
Healthcare providers that make Patient Protection 1stSM recognize the healing powers of an apology when they commit harm and embed the principles of compassion, kindness and learning it symbolizes into their core values.
Reason # 1 It’s called health care — not health harm.
The status quo is not acceptable and cannot be tolerated any longer… it is simply not acceptable for patients to be harmed by the same health care system that is supposed to offer healing and comfort.
Those words come not from a family harmed by medical error but from one of the most prestigious healthcare organizations in the world. They were set out in the landmark report of the Institute of Medicine’s review of the state of patient safety in America, released in 1999.
It is estimated that each year, hospital harm claims the lives of nearly half a million patients in the United States and Canada. In the U.S. alone, some 15 million are harmed by hospital incidents. That’s about 40,000 every day. Thousands more die from infections acquired while they are being cared for in U.S. and Canadian hospitals. The costs to healthcare payers from these avoidable errors is in the billions. The devastation to the families affected is beyond calculation.
Healthcare providers that make Patient Protection 1stSM acknowledge the risk faced by patients in the hospital setting and the need to combat this epidemic of errors. They take every step and employ every best practice to minimize the risk, while being fully transparent in disclosing how they measure up to that challenge and what they are doing about it.
The Center for Patient Protection’s campaign Keep Me Safe — Make Patient Protection 1stSM seeks to combat the epidemic of hospital harm and encourage healthcare providers to adopt more patient‐and‐family‐centered values, like the ten principles set out above.
We believe that only when patients and families become fully informed and demand these values, and hospitals learn to deliver them as a fundamental standard of care, can there be any genuine hope of safer and more positive outcomes for patients and families in the healthcare setting.
If you agree with the principles behind our campaign to make Patient Protection 1stSM and why they are so important to the well‐being of patients and families, we would like to hear from you.
Only when patients and families become fully informed and insist on these principles of care, and hospitals learn to deliver them as a fundamental duty, can there be any genuine hope of safer and more positive outcomes in the healthcare setting.
Let us know what you think.