Stacy E. Walz, PhD, MT(ASCP), ASCLS Patient Safety Committee Chair
Way back in the late 1990s, patient safety and medical errors were highlighted in a groundbreaking report entitled, “To Err Is Human,” followed quickly by another report entitled, “Crossing the Quality Chasm,” suggesting six aims for high quality healthcare. Those six aims—safety, effectiveness, efficiency, patient-centeredness, timeliness, and equity—became goals for healthcare facilities and professionals alike, but not overnight, and not evenly across regions or professions. In fact, the medical laboratory field remains in the fledgling stage of adoption and application of these aims, both in practice and in education.
But even in fields and regions where patient safety initiatives have made their way into education and practice, the United States is having only limited success in reducing medical errors and improving patient safety, even 20 years after the initial reports were published. To temper a “doom and gloom” statement like that, though, the definition of what constitutes a medical error has broadened, and improvements have been made in detecting them.
The experiences the U.S. healthcare system is having in the throes of this pandemic continue to highlight the importance of these fundamental aims and how they intersect with a public health response.
In a pandemic response, the focus is on a population of people and less on individuals. However, individual behaviors, health status, socioeconomic status, and a variety of other factors all impact the population. In an attempt to keep an entire population safe, public health officials ask individuals to employ strategies to reduce the spread of the organism, such as wearing masks in public and staying home if feeling ill. The strategies employed, unfortunately, are never 100 percent effective, and neither is the buy-in from all individuals in the community. It is virtually impossible to keep an entire population safe!
In a public health response, patient-centeredness almost goes out the window as we strive to set aside personal preferences and consider the bigger picture. When individuals present to the healthcare setting for diagnosis and treatment, of course they are evaluated as individual patients. But data collected from individuals in a pandemic is shared at a population level in an effort to learn more about the spread of the organism, the manifestation of the disease, procedures and medicines that work or don’t work, and risk profiles of those most gravely affected.
With a novel organism, it is challenging to employ the most effective treatments or mitigation strategies because we haven’t yet learned what those are. From the public’s standpoint, what looks like confusion and conflicting information, is actually the scientific process happening in front of our very eyes. The quality aim of effectiveness is a huge challenge to achieve in this situation.
Efficiency and Timeliness
As everyone knows, the laboratory received a lot of press in regard to testing for the novel coronavirus. The challenges surrounding test methodologies, supply chain shortages, personnel shortages, and communication of test results with public health entities were played out in the public’s eye. Laboratory professionals were tasked with implementing new systems and new tests in rapid fashion, dealing with an enormous influx of specimens for testing, training staff to perform the tests, creating new lines of communication for public health reporting, and sometimes even getting involved in the mass collection of nasopharyngeal swab specimens. The quality aim of timeliness in turnaround of test results was impacted greatly in many settings. With some less sensitive and/or specific test methodologies and platforms being released quickly under the FDA’s Emergency Use Authorization, efficiency was negatively impacted as laboratories had to repeat testing using more accurate methods.
Last but not least, the pandemic has highlighted inequities in access to care, access to testing, and inability to undertake some of the measures recommended by the public health agencies (such as self-quarantining) to mitigate the spread of the virus.
Although the pandemic has disrupted virtually every aspect of life, guiding principles will be important in many areas as we move toward a new version of “normal.” If we keep the six aims in our sights, these concepts can provide guidance to keep us on track for a higher quality healthcare system.
Stacy Walz is Associate Professor and Chair of the Clinical Laboratory Science Department at Arkansas State University in Jonesboro.