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Statement urges accountability for patient safety


To enhance quality of care, strengthen patient safety protection and minimize costly medical errors, healthcare provider organizations should expect all clinical staff to be accountable for achieving meaningful quality improvements and reporting potential safety risks, according to a new statement from the National Association of Healthcare Quality.

The right approach allows healthcare professionals to feel empowered and protected when reporting concerns about potential risks and adverse events, according to the NAHQ’s “Call to Action: Safeguarding the Integrity of Healthcare Quality and Safety Systems.”

“A strong safety culture is essential for any healthcare organization to maintain effective quality monitoring processes and ultimately preserve the integrity of healthcare quality and patient safety systems,” Susan Goodwin, RN, MSN, immediate past president of NAHQ and assistant vice president of HCA in Nashville, Tenn., said in a news release. “Without a strong safety culture, frontline providers and management may fail to identify a concerning pattern of performance or a single event or may hesitate to report them.

“In any given situation where quality or patient safety is called into question, the process by which an issue is raised is considered as important as the query itself. Not every concern about patient safety or quality of patient care will ultimately be deemed valid, but every reported concern deserves serious consideration. A culture that encourages such disclosures is critical to improved patient care.”

The “Call to Action” provides detailed recommendations adopting best practices to enhance provider institution quality, improve ongoing safety reporting and protect staff. NAHQ collaborated with several national healthcare professional organizations in developing the recommendations, including the American Nurses Association, American Organization of Nurse Executives, American College of Physician Executives, American Health Information Management Association, American Medical Association, American Society for Healthcare Risk Management, National Association Medical Staff Services, National Association of Public Hospitals and Health Systems, National Patient Safety Foundation and The Joint Commission.

“We are calling on U.S. healthcare organizations to build on their achievements to ensure the integrity of quality evaluation and measurement by fostering even stronger safety cultures and processes,” said Cynthia Barnard, MBA, the paper’s lead author and director of quality strategies for Northwestern Memorial Hospital in Chicago.

High stakes

Barnard noted such actions are good business as well as good medical practice, “especially as accountable care organizations, which tie reimbursements to quality measures, are becoming more prevalent in the market.”

Many health insurers link payments to quality outcomes and will withhold reimbursement for hospital-acquired conditions. “We hope this action by payer groups helps eliminate incentives in healthcare organizations that impede efforts to improve patient safety and quality,” Barnard said. “It certainly raises the stakes for reporting less than optimal outcomes.”

Although studies have showed that more than 85% of those who report concerns about performance or misconduct in healthcare facilities have positive experiences, room for improvement remains, according to NAHQ. The Institute for Safe Medication Practices has reported that 40% of clinicians either keep quiet or remain passive after witnessing an improper patient care event to avoid possible reprisals. In a 2010 straw poll of NAHQ members in leadership positions, three in four respondents said they personally had experienced an incident of ethical and professional concern related to reporting quality or safety concerns.

NAHQ’s members are healthcare quality professionals who conduct thorough and objective reviews of a provider organization’s overall quality and safety. They evaluate and investigate potential quality problems and report them to appropriate management. To be effective in this role, according to NAHQ, they must be assured protection. The same holds true for those in other roles that encompass responsibility for quality and patient safety, such as an organization’s executive administrators, CMOs, CNOs, other clinical leadership, risk managers, medical staff services professionals and health information management professionals, among others. Each must be supported and protected in performing their patient safety and healthcare quality oversight roles without undue or inappropriate pressure to suppress or withhold reporting of concerns.


In the “Call to Action,” NAHQ offers several practical recommendations to assure that the integrity of quality processes within a healthcare institution is maintained.

Create a focus on accountability for quality and safety as part of a strong and just culture: Educate employees continually about expectations for timely reporting of quality and safety concerns. Publicize ethical responses to errors and “good catches” through management praise, peer recognition and other techniques. Benchmark regularly by comparing the organization’s performance in responding to quality and safety concerns with peer organizations. Consider engaging patients and families to report their concerns and ideas.

Ensure that protective structures are in place to encourage reporting of quality and safety concerns: Establish explicit policies that support error reporting and penalize reprisals in response to reporting. Respond, counsel and discipline as needed to ensure that egregious violators of policies regarding error reporting are not permitted to work or practice in the organization.

Ensure comprehensive, transparent accurate data collection and reporting to internal and external oversight bodies: Establish quality improvements so that data collected are applied to foster improvements in patient outcomes. Set policies that protect data integrity and communicate to clinicians any identified gaps in patient care processes.

Ensure effective responses to quality and safety concerns: Immediately investigate and respond to any adverse event, complaint or concern. Implement effective action plans to address vulnerabilities and gaps in quality and safety processes.

A PDF of the report is available at


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