“What one change improves hospital quality and patient safety the most?” I get some form of this question every time I describe my work with the Essential Hospitals Engagement Network to reduce hospital-acquired conditions.
Of course, there is no single change to a multifaceted care delivery setting that can guarantee improved patient safety. But in a world with limited resources, I understand wanting to which solution provides the biggest bang for the buck.
So how do I respond? I say patients can be more active partners in ensuring all precautions are taken to minimize the risk of harm, and that this depends on providers supporting an environment that fosters such partnerships. In other words, I am talking about patient and family engagement.
My response echoes this year’s Patient Safety Awareness Week (March 8-14) theme of “United in Safety.” From patients and families to clinicians and administrators, we all have a role in promoting patient and family engagement for safer care.
Growing Evidence for Patient and Family Engagement
A systematic review in 2010 on the effectiveness of interventions to promote patient involvement in patient safety found limited evidence connecting patient involvement to reductions in incidents of patient harm. But since 2010, more evidence has surfaced highlighting the positive impact of patient engagement.
One of the more recent studies, published this month in Health Affairs, looked at changes in patient activation levels relative to health outcomes and costs. The study found that as patients’ knowledge, skill, and confidence in managing their health care grew, clinical indicators associated with diabetes and heart disease improved alongside reduced emergency department visits.
How Hospitals Can Engage Patients and Family
Effective patient engagement is not a straightforward proposition for either the patient or the provider. I experienced firsthand, when I broke my jaw two years ago, how awkward it is to broach the subject of patient safety with clinicians, while trying not to undermine their knowledge and skill. I could tell some nurses were bewildered and a little annoyed that a scrawny guy in his 20s was concerned about pressure ulcers. Fortunately, there are practical guidelines on how health care providers can support patient involvement in patient safety.
Here are some tips mentioned in a systematic review published this month on patient participation in patient safety, along with related examples from essential hospitals:
- Have organizational oversight of patient and family engagement activities so there is a system to address barriers and provide resources.
- San Francisco General Hospital’s patient advisory boards ensure the partnership between providers and patients and families continually improves.
- Engage the patient’s family when a patient’s ability to engage is reduced by illness.
- By eliminating restrictive visiting policies, Contra Costa is better able to engage families on behalf of ill patients.
- Educate providers on engaging with patients to avoid negative reactions to perceived challenges from patients and from giving discouraging responses.
- The University of Missouri Health System has a live simulation center to help physicians learn to communicate better with patients. This includes responding to nonmedical issues.
- Use video to increase patients’ comfort in engaging in safety-related behaviors.
- San Francisco General Hospital developed a video to encourage patients at risk of falling to call hospital staff for assistance when walking to the bathroom or around their room.
- Have patient role models engage other patients by talking about shared experiences.
- Rancho Los Amigos National Rehabilitation Center’s KnowBarriers offers peer mentoring and life coaching to help patients create a vision of personal success, build confidence, and achieve life goals.
While patient and family engagement is my short answer to the question of what change can have the biggest impact on patient safety, the reality is my answer encompasses a lot of changes. This is why I do not envy the decision-making responsibilities of hospital administrators.