AHRQ Swings and Misses on New Patient Safety Report

As I’ve said before, healthcare providers know how to make patient care as safe as possible. They just lack the total commitment and the right financial incentives to do so.  

With that bias in mind, another report destined for an email or file folder is out on how to make care safer. This one is from the U.S. Agency for Healthcare Research and Quality no less, and you can download the 69-page report here. 

There’s a lot to like in AHRQ’s Strategies to Improve Patient safety: Final Report to Congress Required by the Patient Safety and Quality Improvement Act of 2005 besides its long title. 

One thing to like is its focus on practical strategies and tactics to reduce medical errors and increase patient safety, and it puts all those strategies and tactics in one place. In fact, the report features 28 tables of searchable strategies and tactics on topics like care transitions, diagnostic errors, infection control and patient engagement. If you’re a provider, there’s no excuse for not finding what you’re looking for. It’s there in this report. 

Another thing the report does right is identify ways that help providers to actually use the strategies and tactics. For example, AHRQ recommended that providers:

• Use “analytic approaches in patient safety research, measurement, and practice improvement to monitor risk”
• Implement “evidence-based practices in real-world settings through clinically useful tools and infrastructure”
• Develop “learning health systems that integrate continuous learning and improvement in day-to-day operations”
• And use “patient safety strategies outlined in the National Action Plan by the National Steering Committee for Patient Safety”

We commented on the National Action plan in a previous post, “Putting the Patient in Patient Safety,” way back in September 2020.

What the report swings and misses on is something we believe at 4sight Health, and that’s the direct link between payment and outcomes. We won’t get the care we want until we start paying for the care we want. And the care we want is safe, as in safe as humanly possible. 

The AHRQ report stops short of making that connection between money and safety and admits it:

“This report does not address mechanisms for setting, incentivizing, and/or enforcing compliance with patient safety-related standards or requirements, or for holding providers accountable, such as professional licensing and discipline and healthcare facility licensing and certification,” AHRQ said.

Further: “Consistent with the framework and purpose of the Patient Safety Act, this report addresses strategies to be encouraged for use in voluntary patient safety improvement activities conducted by, with, and/or for healthcare providers.”

No financial incentives. No regulatory compliance. No provider accountability. 

I wouldn’t go to a restaurant under those conditions. But we have to go to the doctor or hospital under those conditions when we’re sick or hurt. 

Yet another reason why we need a customer revolution in healthcare.

Thanks for reading.