How to seize on opportunities to improve safety and patient experience

HealthLeaders: What are the primary elements of patient experience?

James Moses: Patient experience is extremely important. The main elements are patient-centeredness and thinking through how care is personalized for every patient. Patient experience is more than just patient satisfaction. Patient experience is about the experience we are providing to patients and whether they walk away feeling like the experience was something they felt positive about.

The patient experience is also about respect. When you do not tailor care to individuals, it is a form of disrespect. If providers are not doing their homework prior to clinical visits to really understand the patients who are in front of them and the active issues, that can be perceived as a sign of disrespect. If patients do not feel that their concerns are being heard, that is not achieving the patient-centeredness and the personalization aspect that you want in the patient experience.

Eventually, what we are seeing in telemedicine and digital health will help facilitate and accelerate the personalization of healthcare. That is something to be excited about.

HL: Where do you see the opportunities to improve patient experience?

Moses: One area of opportunity is continuity of care. The team of providers needs to act as a team.

Sometimes, you go to one provider, and they act completely independent of other the providers and specialists. You have a one-off experience instead of continuity and a sense that your caregivers know you. Too often, I see providers asking patients for an update on what the other doctors have said, which is not patient-centered and not the right patient experience. There needs to be much better effort around systems of healthcare and ensuring that they are functioning in a coordinated way across multiple services, so that care can be tailored across the care continuum in a way that makes the patient feel respected and their physicians are all on the same page.

Patients need to know that the right thing is going to be done in clinical decision-making as well as the coordination of evaluations, diagnostic workups, and treatments. In healthcare, patients fend for themselves quite a lot, and we have to remove those types of barriers and remove discoordination in their care.

HL: Patient safety has been a top goal in healthcare since the publication of To Err Is Human two decades ago. Which patient safety areas remain problematic?

Moses: One of the continuous areas of opportunity is around diagnostic errors. There has been a lot of discussion around why providers and clinicians make the wrong diagnosis and what is happening around their decision-making process that is getting them to head down the wrong path. We need to make sure that clinicians can step back and take a nuanced view to ensure that they are making the right diagnosis and to confirm that the diagnoses they are making are in line with what they are seeing clinically.

Another area is related to growth of procedures happening in the ambulatory space. Historically, we have had a lot of surgical procedures and other types of invasive interventions in the hospital-based environment, which is a very controlled setting. One of the areas that has presented new risk is a push toward having ambulatory procedures and not necessarily having the same safeguards in place as we had in the hospital-based operative arena.

Another area is communication among teams and across transitions. We still have work to do to ensure that we have robust communication around transitions and ensuring robust continuity of care between teams. That is going to be a continued area of priority and focus for all of healthcare for the foreseeable future.

HL: Where are the opportunities to improve communication?

Moses: Handoffs and transitions of care continue to be an opportunity.

When the emergency department is admitting patients to the inpatient area or there are surgical patients coming up from the operating room to a surgical ICU, there continues to be opportunity to ensure that teams are using standardized communication tools to help with the adequacy of handoffs and to make sure that everybody understands the key areas of care that need to be handed off.

In the transitions of care between providers and the ambulatory space, you are not in such an acute situation. But often, we see providers side-step direct communication between specialists and primary care doctors—they often communicate through their medical documentation, which is not the same as having huddles around complex patients with specialized needs. Patients would benefit if there were more planned communications.

HL: In healthcare, how far away are we from seeing the degree of safety that we see in the aviation industry?

Moses: Unfortunately, we are pretty far away from that level of safety. Healthcare is not like flying one airplane at a time. It is like flying hundreds of thousands of planes every day all at the same time. So, there is a high level of complexity that we deal with in healthcare. We do not have the safeguards we need to have in place to the extent that they should be in place.

It is going to be a long journey, but it does not need to be a forever journey. What I would like to see is a national focus on safety events and harm from safety events. That would help organizations to understand the true north of keeping patients safe. Having a national priority on patient safety would make the journey quicker as well as more robust and transformative.

It also would be beneficial for organizations to be more transparent about the frequency of harm events. When you look at the measures that we report, they are preventable harm measures and patient experience measures. But we do not have a national framework for reporting serious safety events in a way that allows folks to come together to learn best practices and to objectively understand how one organization may be doing a better job or worse job.