I recently spent almost five years engaging with the Patient Safety Movement across North America. The nonprofit with whom I worked not only initiated their own programs and services to improve patient safety but we also provided grants for the work of many others. At the end of that time I would describe myself as disappointed. I was not disappointed in the passion I felt when encountering patient safety advocates but rather in the entrenched resistance in many healthcare systems and the indifference of the general population, at least until the moment when they faced the possibility of medical errors or unsafe practices by their doctor or hospital. Add to that resistance and indifference the inability to find an adequate business model – be it for profit or nonprofit – to be a funded patient safety advocate and you get a picture of how bleak this field can feel to patient safety advocate insiders.
In fact, the only bright spots I have seen have come from progressive healthcare providers able to present patient safety activities within the context of improving the financial bottom line. I believe what is needed in the U.S. are patient safety advocates who are independent from the very systems they wish to see change. It just isn’t enough to trust only in those nonprofits who, with patient safety as a strong focus, depend upon healthcare insurers, providers, societies or big pharma for their budgets. The risk of being coopted is just too great. An effective business model to achieve such independence is, I believe, the Achilles Heel of the Patient Safety Movement.
This is where health advocacy can help the Patient Safety Movement. Health advocacy includes patient safety issues as a part of its mandate. Rather than that meaning patient safety issues get “watered down,” it provides a larger context for assisting patients by offering additional help needed by patients. Health advocates assist patients in medical, eldercare, insurance, legal and administrative areas regarding their long-term or acute care needs. Many health advocates do not provide all of what is in that list but the breadth of what they are able to cover is, I would argue, a more attractive service to patients and patient families than just patient safety. After all, most patients have the view that their doctor would be sure to keep them from any unintended harm, so why think about something – patient safety – their doctor already has covered? Of course, we know this is not true, otherwise how could more than 500,000 people die in U.S hospitals due to medical error every year? Just look at an August 2015 blog post about the 2014 record of 29 “never events” categories in Massachusetts hospitals: http://www.thepatientsafetyblog.org/2015/08/29-never-events-hospitals.html.
There is more in health advocacy to commend it. Medical schools are already adding health advocacy to their course curriculum and it is possible to see a path forward that could make a career in service of this type much more potentially viable than what presently exists for patient-safety-only advocates. I say “potentially” because the health advocacy field is still facing the need for a bona fide credentialing platform, a universal set of core competencies, and an agreed reimbursement stream. Even with those currently missing elements, health advocates have a much better chance of a future successful professional environment than do patient safety advocates, in my estimation. Many hospitals have already begun to hire staff as Patient Navigators. But just as patient safety advocates can be coopted by healthcare systems that provide funding for their work, so too can Patient Navigators because the needs of patients are not always aligned with the needs of the healthcare system through which they are served.
I hope it is clear that my purpose here is not to trash talk patient safety advocates but rather to suggest that there is a way for a win-win situation for these two important patient-related fields, where each field could be enriched. Many people I have met working in the field of patient safety are motivated because they themselves have suffered some kind of a loss due to medical error, sometimes grievously so, by losing a loved one in an untimely manner, because of errors. They strongly desire that no one else has to go through what they went through. But passion alone is seldom sufficient for a viable business plan.
Are there challenges facing such a “marriage” of movements? Yes. But I believe it is time for a discussion. The health and safety of patients are principles deeply embedded in both movements. Let’s talk.