The View from the C-Suite on Improving Patient Safety in Hospitals

According to a recent study, more than 400,000 patients die in U.S. hospitals each year due to preventable medical errors.¹   This figure, which is based on a new analysis of existing data, is more than four times the previous estimate and points to the tremendous importance of enhancing patient safety in hospitals.²

AIG recently conducted a survey of 350 C-suite executives and risk managers at hospitals in the U.S., with the goal of learning what drives patient safety and what barriers might be standing in the way of improving it.³   The findings reveal that patient safety is those leaders’ number one priority.  But they also uncover multiple tensions between competing objectives in the hospital environment that are, in many cases, standing in the way of improving patient safety. 

A Balancing Act

One of those tensions lies in the need to provide for outstanding care and patient safety while maintaining a financially sustainable institution.  The difficulty in trying to deliver topflight customer service and maintaining reasonable costs and profit margins is a challenge that’s familiar to companies in a wide array of industries.  But in healthcare, success in the former objective is paramount, because compromising patient safety for the benefit of the bottom line can literally have fatal consequences. 

Nevertheless, achieving both objectives is important, and, inevitably, hospital executives are feeling the pressure of trying to balance their time between them.  While two-thirds of the respondents surveyed agreed that maximizing patient safety was their top priority, the same percentage said that failing to maximize financial sustainability was the biggest threat to their hospitals.  The survey revealed that the time spent on trying to achieve each objective (patient safety and financial sustainability) was disproportionate to the objective’s stated importance.  Put simply, more time was spent on trying to secure financial sustainability than was warranted by its relative ranking among the executives’ stated objectives, while in the case of patient safety, the opposite was true.  

To counter this difficulty, hospital leaders will need to find a way to position patient safety and financial sustainability as complementary goals, not competing objectives.  

Who Owns Patient Safety?

Once a patient checks into a hospital, who is responsible for his or her safety?  According to the survey results, the answer is somewhat mixed and depends on just what is being asked. 

Virtually all (98%) of the leaders surveyed agreed with the statement that “every staff member in my hospital is responsible for, patient safety.”  However, when asked who “owns,” or has primary responsibility for patient safety, just over half said that nurses do.  Nevertheless, in a finding that revealed another potential tension in the survey, these same respondents believed that turnover among members of the nursing staff was one of the least influential factors relating to overall hospital risk – a belief that conflicts with some studies.⁴

What Did You Say?

A third principle finding of the survey was the view that the number one barrier to improving patient safety in hospitals was a “lack of teamwork, negative culture, and poor communication” among hospital staff.  Part of the difficulty may be due to a lack of trust: more than a quarter of the respondents believed that nurses may sometimes hesitate to speak out about potential safety problems due to fears of retribution from management.  

Another contributing factor may simply be that, when it comes to patient safety, staff members are talking past one another.  Roughly half of the leaders surveyed believed that different staff members across their hospitals had different takes on what constitutes patient safety.  If correct, then an effort to develop and promulgate a consistent and viable definition of this key concept would pay dividends in terms of better coordination and communication among staff members. 

Building a Coherent Strategy for Improving Patient Safety

Despite the challenges, U.S. hospitals work miracles every day in terms of lives saved and improved by the highly skilled and dedicated professionals who work in them.  As the survey reveals, patient safety is already the number one priority of hospital leaders.  At AIG, we hope that the survey’s additional findings will serve as food for thought on how future improvements to patient safety might best be achieved. 

^{1. James, John T. “A New, Evidence-Based Estimate of Patient Harms Associated with Hospital Care.”  Journal of Patient Safety: September 2013 - Volume 9 - Issue 3 – pp. 122–128.  doi: 10.1097/PTS.0b013e3182948a69.  Available for free download online at http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx
2. For discussion, see Leah Binder’s “Stunning News on Preventable Deaths In Hospitals,” Forbes, Sept. 23, 2013.  Accessed online on Sept. 19, 2014 at  http://www.forbes.com/sites/leahbinder/2013/09/23/stunning-news-on-preventable-deaths-in-hospitals/
3. “Patient Safety; Hospital Risk: Perspectives of Hospital C-Suite and Risk Managers.”  AIG survey, April 2013. 
4. For example, one study concluded: “Managing nursing unit turnover within appropriate levels at the nursing unit is critical to delivering high-quality patient care.”  Sung-Heui Bae et al.  “Impact of Nursing Unit Turnover on Patient Outcomes in Hospitals.”  Journal of Nursing Scholarship, Volume 42, Issue 1, pp. 40–49, March 2010.  For abstract and above quote, see  http://onlinelibrary.wiley.com/doi/10.1111/j.1547-5069.2009.01319.x/abstract;jsessionid=F3A7DAED19B62C360C7466C8262565B4.f02t03}