Georgetown Experts Tackle Complexities of Patient Safety

Posted in GUMC Stories

OCTOBER 10, 2014—Georgetown University Medical Center (GUMC) convened an expert panel to discuss the challenges of creating and maintaining a culture of patient safety at the latest installment of its Doctors Speak Out series.

Titled “Blue Ribbon Standards for Patient Safety: The Georgetown Approach to Excellence,” the discussion took place Oct. 7 at the Georgetown University Hotel and Conference Center. Doctors Speak Out is GUMC’s signature quarterly luncheon series that invites leading Georgetown physicians and scientists to discuss timely health topics with members of the community.

The panelists concurred on one key point: given the highly complex nature of modern health care, there is no silver bullet to achieving patient safety. Rather, it requires a multifaceted, comprehensive, team-based approach to patient care, along with a shift in education to train future health professionals in a more collaborative style.

“There are two major reasons why it’s not easy: first, we are dealing with human beings who are delivering the care, and second, we work in a very complex health care system,” said Seth Krevat (M’00), MD, assistant vice president for safety at MedStar Health.

Factors contributing to this complexity are facilities, which are not generally designed around the patient’s or provider’s needs, and technology, which is continuously changing in the health care setting.

Krevat was joined on the panel by Anne Gunderson, EdD, GNP , professor of medicine and associate dean for innovation in clinical education at GUMC, and assistant vice president for education, safety and quality at MedStar Health, and by Bernard Horak, PhD , professor and director of the health systems administration graduate program at Georgetown’s School of Nursing & Health Studies .

The discussion was moderated by Rosemary Gibson , senior advisor at The Hastings Center and editor for JAMA Internal Medicine.  

A National Priority

Horak defined patient safety as “doing things right, the first time and every time for every patient.”

While this sounds deceptively simple, he explained that there are three categories where safety issues emerge: overuse, or doing too much for the patient; underuse, or not doing what is recommended; or misuse, which refers to medical error.

Because these are nationally recognized phenomena, accrediting agencies and professional societies have put in place a litany of patient safety standards and guidelines for hospitals and physicians—and the government has created accountability by implementing penalties for improper care.

“Nationally, we have seen a lot of momentum in this area,” Horak said.

Rethinking Education

Gunderson said that besides the inherent complexity in the system, making the necessary changes now in medical and nursing curricula to emphasize patient safety and quality is imperative—but not easy.

“Our basic medical education in this country is based on a structure from about 1911. It’s a challenge for medical schools to [approach education with] safety and quality [in mind],” she said.

She noted that Georgetown is ahead of the curve in this regard, having incorporated innovative interprofessional training into the curriculum of its medical and nursing schools, and through a new master’s degree in safety and quality leadership—currently under development—for practicing health care professionals.

“It will be a different world for our children and for generations to come. Georgetown has embraced this in a huge way,” she said.  

Horak stressed that Georgetown’s emphasis on interprofessional education puts medical and nursing students side-by-side in the clinic and in the classroom—a new way to learn that helps break down silos once they graduate.

Everyone Has a Voice

Every person on the health care team has a voice in making patient safety a reality—including doctors, nurses, residents, medical students, physicians’ assistants, nurse practitioners and even hospital housekeeping staff.

Safety is everyone’s responsibility, Krevat stressed, and empowering all members of the team to speak up—without fear of reprisal—is critical.

“Everyone wants to blame someone when something goes wrong. It is quick and easy and makes us feel better, but it doesn’t fix the problem,” he said.

Gunderson said that patients and families are another key piece of the puzzle. If a patient or loved one sees something or experiences something that makes them uncomfortable or raises a question, they should always ask.

“You are your best advocate and you are our best advocate,” Gunderson said. “The more you partner with your physician, with your nurse practitioner, with whomever you are seeing, the more that will make a difference in your care.”

Gibson added that safety affects everyone’s daily lives.

“There is a role for all of us, as patients or as family members, whether in the hospital, in the doctor’s office or at home with our own medicine chests, we all have a role in this,” she said.

By Lauren Wolkoff
GUMC Communications