“I believe we are at an inflection point in the history of improving patient safety. Changing payment models, the uncertainty surrounding health reform, and the ever-increasing scrutiny of the modern digital age demand fresh and creative thinking on how best to ensure harm-free care.
At IHI’s National Forum in December 2016, I proposed six patient safety “resolutions” for the new year — to ensure the great strides already made are sustained and to expand our thinking about safety:
1. Focus on what goes right as well as learning from what goes wrong;
2. Move to greater proactivity;
3. Create systems for learning from learning;
4. Be humble — build trust and transparency;
5. Co-produce safety with patients and families; and
6. Recognize that safety is more than the absence of physical harm; it is also the pursuit of dignity and equity.
The first five aren’t wholly new, and they align with IHI’s approach to quality improvement in general. The sixth is one I’ve been thinking a lot about over the past few years. Now that we know how to reduce and even eliminate harms that some once thought inevitable — ventilator pneumonias, central line infections — we need to devote our efforts to eliminating harms we’ve yet to focus on explicitly. Harms caused by indignities and inequities in health care are just as preventable, and just as unacceptable, as wrong-site surgeries and medication errors. We’re only beginning to understand how physical health is affected by psychological trauma. Ensuring patient safety is about ensuring the right all patients have to a free-from-harm care experience, which includes being treated equitably and with dignity.”
The foregoing excerpt from the Foreword by Derek Feeley, President and CEO, Institute for Healthcare Improvement, to the 2017 white paper by Institute for Healthcare Improvement and Safe & Reliable Healthcare entitled “A Framework for Safe, Reliable, and Effective Healthcare” (http://www.ihi.org/resources/Pages/IHIWhitePapers/Framework-Safe-Reliable-Effective-Care.aspx) summarizes a set of “resolutions” for improving patient safety. Although laudable and feasible, they are only marginally practicable and reliable; because they pertain to so-called “human factors,” which are themselves inherently unreliable because they depend on human individuals and circumstances that lead to cognitive overload (arguably the root cause of medical mistakes).
The one redeemable exception among the five resolutions posited is “3. Create systems for learning from learning,” provided that such systems be automated so that they may be run recurrently in the reliably repeatable manner characteristic of information technology (IT) solutions. The tactic for implementation of such solutions not to “rip-and-replace” installed EHRs and/or departmental/ancillary systems but, rather, to leverage the hard-won connectivity and functionality they represent with a “wrap-and-reuse” approach. A cloud-based intelligent business process management suite conforming to the Cloud Healthcare Appliance Real-Time Solution as a Service (CHARTSaaS) reference architecture can implement such an approach by enabling healthcare provider subject matter experts to design, develop and deploy IT applications a.k.a. “apps” with minimal cost and complexity (i.e. — minimal IT staff support and no addition to installed IT systems). Such apps can provide the cognitive support (cognitive overload being arguably the root cause of medical mistakes) needed for cost-effective medical practice and healthcare delivery positive transformation with their included capabilities that can be implemented using a low-/no-code integrated development environment for continuous/real-time operation:
- complex event monitoring using both parameter value and time specification,
- similarity/Bayesian and predictive analytics,
- rule-based/Boolean decision support,
- state-managed/long-running process execution with system and staff choreography,
- accessibility via any/all client system form factors (e.g. — desktop, tablet, phone),
- connectivity to user/on-premise systems/applications and Web-accessible apps.
Please validate this proposition to your own satisfaction by reviewing the details of CHARTSaaS and the CHARTSaaS RA in these presentations, and then by imagining a CHARTSaaS-enabled IT solution:
Healthcare providers and their patients will benefit significantly from appreciating and then applying a CHARTSaaS RA-compliant IT solution. To do so will mitigate medical mistakes (currently the third leading cause of patient deaths, per Makaray and Daniel, http://www.bmj.com/content/353/bmj.i2139), thereby minimizing patient adverse events; and also will optimize clinical case outcomes while maximizing the cost-effectiveness of care and treatment and accelerating the accrual of medical knowledge.