One global pandemic.
That’s all it took to reveal the shaky foundation underpinning patient safety efforts in most American hospitals and healthcare systems. And just as a building lacking strong support can splinter and crumble during a hurricane or earthquake, cracks and crevices in the patient safety system appeared when the COVID-19 crisis shook the healthcare system.
Hospital-acquired infections increased, in many places despite increased attention to infection control. According to an article published in the November 2020 issue of the American Journal of Infection Control, a hospital in New York experienced a 420% increase in CLABSIs and 179% increase in CAUTIs. A similar-sized hospital in St. Louis experienced a 324% increase in CLABSIs and a 57% increase in CAUTIs.
During the pandemic, “safety culture” scores declined significantly among a sample of 54 hospitals across the United States, according to a white paper by Press Ganey. The Agency for Healthcare Research and Quality (AHRQ) also noted an “alarming” 40% reduction in staff perceptions that management made safety a priority.
Now that the COVID-19 crisis has eased, it’s time to reinvigorate patient safety efforts.
It’s human nature: We hyper-focus in crisis. Even though the U.S. Centers for Disease Control and Prevention (CDC) emphasized the importance of hand hygiene in combating the novel coronavirus, data collected by Clean Hands – Safe Hands reveals that handwashing decreased at healthcare facilities that did not use automatic voice reminders to reinforce hand hygiene expectations..
One possible explanation: the stress caused by the pandemic contributed to a significant decline in “Resources and Teamwork,” one of the three safety culture categories assessed by Press Ganey. (The other two are “Prevention and Reporting” and “Pride and Reputation.”) This category reflects communication and collaboration between staff members, as well as staffing levels. Scores for “Prevention and Reporting” declined as well, as staff confidence in administrators’ attempts to improve patient safety plummeted.
In the face of ongoing stress, safety initiatives crumbled. As Leah Binder, president and CEO of The Leapfrog Group, noted in a Forbes article, hospitals’ experience with COVID-19 shows that “all the work on safety culture has not become hard coded or habit and that it could deteriorate under stress, which is exactly when you need that culture to be the strongest.”
The Press Ganey report, Reverse the Trend: Improving Safety Culture in the COVID-19 Era, says the pandemic “reinforced the importance of highly reliable systems in keeping patients and the workforce safe from harm.” Relying on human effort to fuel safety initiatives is not nearly as effective as creating and implementing sustainable, automated systems and processes.
In a July 2020 Health Affairs article, Carolyn Clancy, AHRQ director from 2002-2013, points out that “health information technology has become a critical enabler of consistent excellence in patient care.” The data generated by electronic hand hygiene systems, for instance, can reveal when (and which) providers are (and are not) engaging in appropriate hand hygiene. Real-time data, such as that provided by Clean Hands – Safe Hands, allows managers and administrators to pinpoint problems and send assistance as needed. Interventions can be targeted and responsive to challenges.
Importantly, electronic hand hygiene systems are not susceptible to human stress and fatigue. Research has consistently found that use of an electronic hand hygiene system can lead to steady and sustained increases in hand hygiene performance, and Clean Hands – Safe Hands data revealed that hospitals that turned on electronic voice reminders after noticing a dip in hand hygiene during COVID-19 experienced an uptick in appropriate hygiene procedures.
As we enter the “new normal,” healthcare leaders must work to shore up the foundations of safety culture. It is time to invest in systems and technology that will protect patients and staff – even in times of stress.