A Q&A with David Goldsteen, MD, VigiLanz Chairman and CEO
Even as hospitals make efforts to improve patient safety, adverse events continue to be all too common. A recent study of 11 Boston area hospitals found that such events occurred in nearly one-quarter of all hospital admissions, and of these events, almost one out of every four was preventable.
At VigiLanz, we’ve dedicated more than two decades to improving patient safety and the delivery of quality care inside hospitals. While we know the industry still has a long way to go, we also recognize that many hospitals are prioritizing patient safety improvements like never before, and we’re heartened by how far many of our hospital partners have come.
In this Q&A, David Goldsteen, MD, former Emergency Department physician and VigiLanz’s co-founder and CEO, explores the evolution of patient safety within hospitals over the past two decades. He shares his take on some of the biggest safety improvements that have been made, as well as the steps hospitals can take to create a safer environment for all patients.
You’ve had a front row seat observing patient safety trends over the past few decades. What are some key ways the patient safety landscape has changed?
While preventing adverse events remains a key challenge for all hospitals, I’ve seen many positive developments over the past few years. These include more awareness of safety events among hospital CEOs, and more initiatives dedicated to eradicating them.
In the early 1980s, many hospital CEOs would say that adverse events were not occurring within their organizations. Now, there’s much more recognition that avoidable and preventable safety events are happening—and that they are happening much too frequently.
As this awareness has grown, hospital leaders have made improving patient safety a much higher priority. This shift means that the most innovative hospital leaders are beginning to truly embrace and foster a culture of patient safety.
You mention that some hospitals are beginning to fully embrace a culture of patient safety. What is that and why is it so important?
While most hospital leaders are moving in this direction, there is still a lot more that many organizations can do to accelerate the momentum. When a hospital fully embraces a culture of safety, three things happen.
One, staff members and physicians are fully encouraged to report safety events. Two, staff and physicians feel comfortable and safe reporting events (they don’t fear retribution). Three, the hospital makes it easy for staff and physicians to report safety events.
When hospitals achieve this state, they have more and faster visibility into the safety events that are occurring, and they can quickly work to prevent similar events from happening in the future. Embracing this culture is essential because it helps hospitals adopt a proactive mentality; it enables them to leverage past experiences to inform predictive algorithms, enabling providers to better anticipate safety events and intervene earlier to improve patient outcomes and prevent injuries across the board.
“Safety shouldn’t be a response to an event. Safety should be something that we embrace because there’s risk in everything we do in healthcare, whether it’s taking acetaminophen or going through a complex procedure.”
—David Goldsteen, MD, VigiLanz Chairman and CEO
Let’s explore the third factor you mentioned—that the hospital must make it easy to report safety events. What are some steps hospitals can take to achieve this?
Ensuring staff and physicians have appropriate resources is crucial. An easy-to-use patient safety reporting system that works well with the EHR is essential. This solution should offer anonymous event reporting functionalities. It should also include automated protocols that spur critical next steps once an event has been reported, such as verification, investigation, root cause analysis, and remediation processes. The solution should also enable leadership to monitor and measure key metrics related to event reporting, to ensure they easily identify continuous improvement opportunities.
This is table stakes for any hospital, but the best patient safety software solutions also offer automated event reporting capabilities, which support and expand on human reporting activities by using a robust set of incident detection rules to automatically identify potential safety events.
While we have pursued this capability with vigor at VigiLanz, it is still very new to hospitals. Only about 10 hospitals across the country are actively embracing automated reporting.
This is unfortunate, because it can be a game-changer in patient safety improvements. In a recent survey of 100 hospital leaders by healthcare consultancy Sage Growth Partners, 86% said automated event reporting is “extremely” or “very” crucial to ensuring safety events are identified.
In addition to event reporting solutions, hospitals need tools that assist with real-time identification of potential harm—before it occurs. These include pharmacy, infection prevention and other surveillance tools that integrate with the EHR and the patient safety reporting system. This full-scale and interconnected approach to improving patient safety is no longer a future concept; it’s here and working today. It just needs to be adopted by hospitals.
All hospitals have EHRs, which do have some patient safety functions. Why are additional solutions so important?
EHRs are essential for hospital recordkeeping and have made great strides in enhancing documentation, efficiency, and patient care. However, by nature of what they do, EHRs need to be very rigid databases. Hospitals need other solutions that work alongside EHRs in order to ensure they can be as proactive as possible in preventing safety events. The most effective technology layers on top of the EHR, and enables hospitals to leverage all of the data within it, in real-time, to identify early warning signs and prevent any compromise to patient safety before it begins.
“We need to recognize that safety events are always going to be with us—this isn’t something that we can eradicate—but, we can manage it better.”
—David Goldsteen, MD, VigiLanz Chairman and CEO
Relying only on the EHR to enhance patient safety is like driving along a steep cliff road without any guard rails for support. There may be heavy signage on the road that alerts you to an upcoming curve, but there’s no additional layer of protection that can prevent a deadly fall.
We’d all be a lot safer if this road had both the signage and the guard rails—just like patients in a hospital would be a lot safer if an EHR and a patient safety reporting system were working in concert to monitor, predict, and intervene.
You’ve mentioned the need for hospitals to ensure staff and physicians have appropriate resources to improve patient safety, but hospitals also are also facing significant financial challenges. How can they balance this against the need to invest in patient safety improvements?
The financial challenges facing hospitals today are very real, but so is the growing threat to patient safety if hospitals do not implement better safety-enhancing solutions. It’s no secret that hospitals are experiencing significant turnover and burnout. Whenever you see that type of tumultuous turnover, safety is naturally going to suffer. But investing in patient safety doesn’t necessarily translate to a long-term financial loss. In fact, it’s just the opposite. Practically speaking, safety events are expensive. Reducing them has a significant ROI. CMS is not reimbursing for errors that lead to prolonged length of stay, for example, and hospitals are experiencing high financial losses due to safety lawsuits and settlements. Hospitals can no longer afford not to invest in safety.
Learn more about how VigiLanz is helping hospitals reduce adverse events and improve patient safety.