In Pandemic’s Wake, We Must Recommit to Patient and Workforce Safety

Nearly three years after COVID-19’s unwelcome arrival, the U.S. healthcare system is still staggering under the strain. The pandemic’s worst aspects may be behind us, but its effects reverberate today among patients, clinicians, and healthcare workers.

Before the pandemic, hospitals were making steady progress toward achieving the kind of patient safety goals that save lives and lower costs. Healthcare-associated infections in hospitals, for example, were trending sharply downward in the years preceding the pandemic. Unfortunately, that trend reversed course between 2020 and 2021, a development that likely represents unwelcome safety trends in other healthcare domains.

Widely reported, as well, has been COVID’s dramatic impact on the healthcare workforce.

Before the pandemic took hold, between one-third to one-half of nurses and physicians reported symptoms of burnout, according to a U.S. Surgeon General report (PDF, 2.8 KB). The high portion of workers under stress has certainly not declined in the wake of the pandemic. A recent report from the U.S. Bureau of Labor Statistics forecasts that about 500,000 nurses are predicted to leave the workforce in 2022, boosting the shortage to more than 1 million.

As the Nation's healthcare delivery systems emerge from the COVID-19 pandemic, numerous priorities for transformation have come to light. They include improving equity, addressing long COVID, harnessing the potential of telehealth and data sciences, responding to climate change, expanding access to behavioral healthcare, and supporting the well-being of healthcare workers. Patient safety is integral to all these priorities. Patient and healthcare worker safety is not a separate priority; it is central to safe, effective healthcare systems.

Mindful that COVID exploited and in some cases worsened key vulnerabilities in the American healthcare system, Health and Human Services (HHS) Secretary Xavier Becerra convened leaders from some of the United States’ largest healthcare delivery systems on November 14, where he publicly recommitted HHS to advancing patient and healthcare workforce safety and held a listening session to learn how HHS can partner with delivery systems most effectively.  The event was attended by 800 people online and 200 in person—in my view a strong signal of consensus about the need to increase our efforts to protect patients and healthcare workers.

I was glad for AHRQ to take the lead in organizing the November 14 event. And I was pleased to be joined by Federal colleagues from the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, and the Food and Drug Administration to share how we plan to work together towards a healthcare system that produces zero harms.  While we may not achieve this vision, to make progress should be our goal. 

In my opening remarks, I stressed that failures in patient safety are not equally distributed and shared recent findings from AHRQ’s 2022 National Healthcare Quality and Disparities Report. Safety will not be achieved until we are all safe.

Central to the meeting was Secretary Becerra’s introduction of HHS’s plan to launch The National Action Alliance to Advance Patient Safety, a public-private collaboration to advance patient and workforce safety together.   

Despite the challenges of the pandemic, there is reason for optimism: We have at our fingertips a blueprint that acknowledges—and offers solutions to—the persistent patient and workforce safety issues we’ve been trying to solve.

Safer Together: A National Action Plan to Advance Patient Safety was released in 2020 after input from 27 steering committee members, who emphasized the urgent need to re-energize and coordinate the work in patient safety, build on our accomplishments, and speed the pace of learning.

Co-chaired by AHRQ and the Institute for Healthcare Improvement, the National Action Plan and an accompanying implementation resource guide provide tactics, tools, and resources for immediate use. The resources are built around four foundational areas: culture, leadership and governance; patient and family engagement; workforce safety; and learning systems. Each of these areas is essential to creating safety across the healthcare system. We’re grateful to the steering committee for their foresight, and we’re confident that the National Action Plan will inform the work of the new National Action Alliance.

For our part, AHRQ will continue in its leadership role by investing in research and building on its collection of evidence-based resources to help health systems and clinicians advance safety efforts. Among them:

• Toolkits to Improve Antibiotic Use: These resources are based on a “Four Moments of Antibiotic Decision Making” model that has shown success in hospitals, long-term care facilities, and ambulatory care practices.
• Tools to Engage Patients and Families in Making Healthcare Safer: Patients and families are powerful partners in improving quality and safety in hospital settings, during primary care visits, or whenever a diagnosis is made. These resources help ensure that patients’ voices are heard.
• Surveys on Patient Safety Culture: This family of surveys asks healthcare providers and staff about the extent to which their organizational culture supports patient safety. Each survey is designed to assess patient safety culture in a specific setting.
• Diagnostic Centers of Excellence:  Grants establishing 10 centers of excellence are aimed at developing systems, measures, and new technology solutions to improve diagnostic safety and quality.

The renewed attention to patient and workforce safety has been energizing and informative. But we’re eager to get more input about the challenges facing healthcare organizations across the Nation and potential solutions to address them. This week, HHS published a Request for Information to help us co-create the National Action Alliance to meet the needs of multiple stakeholders. As we move forward, please stay tuned for ways to receive updates about National Action Alliance activities.

Improving safety for patients and the healthcare workforce will go a long way toward recovering from the consequences of the pandemic. AHRQ looks forward to working with HHS, Federal partners, healthcare leaders, patient and family advocates, clinicians, payers, industry, and other stakeholders to make this goal a reality.

Robert Otto Valdez, Ph.D., M.H.S.A., is Director of AHRQ.

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