Are medical errors more prevalent today than in the past? It's a surprisingly hard question to answer.
"It is almost impossible to say if we have more or fewer medical errors today because we have never been confident that we had a good baseline. We never sought out or collected this information like we do now," said Diane Pinakiewicz, MBA, president of the National Patient Safety Foundation (NPSF).
"A critical characteristic of the culture of safety is transparency, which includes transparency about system imperfections and errors. That requires seeking out and reporting things that have gone wrong so you can learn from them and better tailor your improvement efforts," she said. "This rigor didn't exist in healthcare before, due to fear of malpractice suits and peer pressure. The move to transparency is part of a larger culture change the patient safety work has brought about, which has allowed us to have previously unthinkable processes such as checklists, time-outs and people who can stop a surgical procedure out of concern something will go wrong."
Much of the credit for starting the patient safety movement goes to the NPSF, a not-for-profit founded in 1997 specifically to focus on medical errors and patient safety. Now, to further speed the evolution of patient safety as an essential discipline within healthcare, the NPSF has formed a membership organization for individuals committed to the work: the American Society of Professionals in Patient Safety (ASPPS).
"It's been remarkable," Pinakiewicz said of the interest the ASPPS has kicked up since debuting in February. "We just passed 500 members."
Membership in the ASPPS is open to all medical professionals who count patient safety among their responsibilities, patient advocates and students, as well as others who have an interest in the work.
"The work of patient safety is not vested in one discipline -- it is a team sport," said Pinakiewicz, who also serves as president of the new organization. "It encompasses a set of competencies we feel everyone in healthcare should have. So we wanted to set up an individual membership program than encompassed all disciplines: nurses, physicians, risk managers, medical students, people who hold patient safety titles among their professional credentials, as well as people who don't but who are nonetheless vested in the work, such as people in the environmental services sector."
A lot has occurred in the field of patient safety since the NPSF's founding, Pinakiewicz continued. "Safety has evolved into a legitimate discipline within the healthcare industry," she said. "We mean to continue to raise the level of patient safety as a legitimate healthcare discipline and provide a way for interested people to get engaged in the work."
She envisions the ASPPS growing over the years into a significant membership organization and a critical part of NPSF. "It already has garnered interest from overseas," she said.
The NPSF is also in the process of developing a professional credentialing process for patient safety. This program, to be launched in January 2012, will offer a credential of CPPS -- Certified Professional in Patient Safety. According to Pinakiewicz, it will become the first-ever professional certification program to offer such a credential, something the field needs as it takes its place as a critical, legitimate discipline within healthcare.
"The examination for this professional credential will be offered via computer at designated centers across the country," Pinakiewicz explained. "We are halfway through the work necessary to establish this program and design the examination, deploying the same rigor used for establishing other high-level, professional credentialing. In the process, we are learning a lot about the current state of the field and it is clear it is time to place this rigor around this discipline."
Pressed for more details, she said: "At this point we have a knowledge outline for the exam content and are moving to the writing of the actual exam questions. We will be testing for understanding of the basic patient safety science and competencies and an understanding of how to apply them."
Still to be determined are the baseline qualifications people must possess to sit for the exam. Eager safety advocates are sharpening their pencils, waiting to hear more.
"As soon as we announced we were coming out with a certification exam, people started asking us 'How soon?'" Pinakiewicz said. "People have talked about this for some time and the field is now ready for this next step."
Hand-Wringing Over Hand-Washing
So, is healthcare safer today than in the past?
Well, it's clear that, with each passing day, healthcare grows more complex -- and complexity can breed errors. "We are constantly improving the way we do things critically, but the more complex the system, the more plentiful the opportunities for mistakes," Pinakiewicz observed. "It's a moving target."
Still, the very existence of the NPSF, and now the ASPPS, means the industry is determined to hit that target and score a bull's-eye for safety. "The healthcare industry is a lot better off today than when this work started because of the willingness of the system to look at its processes, and to change the way the culture operates," she said.
Cultures change slowly, though, as does its underlying behavior. For example, the challenges associated with getting people to wash their hands -- a critical tool for managing healthcare-acquired infections -- is a much bigger challenge than it should be, as healthcare staff are not acculturated to doing it, and the culture has not made it at all easy for staff or patients to ask or even to gently remind [someone to wash their hands].
Just last month, Pinakiewicz was herself a patient in an emergency room.
"This doctor was standing in front of a poster that invited patients to ask caregivers if they washed their hands," she recalled. "So I asked him. He just laughed at me. When I said I wasn't joking, he got annoyed, but still did not wash his hands. We still have a lot of work to do."
Michael Gibbons is an editor at ADVANCE.