When Patient Safety is Everyone’s Safety

February 28, 2014

While I have written about patient safety many times, I don’t feel that I have nailed the case for “safety collectivism” — the idea that keeping everyone safe starts by taking care of one.

Current safety regulations almost make safety about the regulation itself rather than about doing what is ethically obligated because we are  “entrusted with the health of another,” as Florence Nightingale put it. A regulation-phobic culture can blind us to the compelling nature of doing what is right in order to do what is right.

Safety-isolationism fragments safety into single risk factors without regard to their broader implications and ignores the contagion of risk.  In other words, if one patient is at risk, all patients are at risk.  Add to that staff and visitors.  To understand what I mean, let’s look at our relationship to fire.

Fire regulations became necessary when rural homes, separated by acres, gave way to urban living.  Given the distance of most houses to the house next door, the last thing we want is to allow the house next door to burn.  Clustered communities that have multiple townhouses or condos sharing walls pushes the concept of shared risk further.

Smoke knows no boundaries.  Its damage spreads.  Smoke is relentlessly persistent its staying power.  In fact, the burned house — and its smoke — is bad for the whole neighborhood.

So, seeing a fire risk, smoke, or fire generally calls for immediate intervention by the person who sees it.  Fire codes, which are by their very nature preventative, provide for easements, smoke detectors, fire extinguishers, electrical safety, and fire alarms in both public buildings and private residences.

Nightingale demanded that hospital buildings themselves do no harm because statistics back then revealed that patients had a far better survival rate at home than in the hospital. And, yet, today, we feel the same way.  We still assume that hospitals are unsafe.

And we tolerate it.

Yes, there is progress. But, as I’ve written before, the most common perception of patient safety being somehow distinct from all other aspects of care is a scary myth.

Patient safety must drive every aspect of care because patient safety is staff safety; is community safety; is our safety. It is a living chain link fence that protects all of us, but is vulnerable to each of us. Bottom line: someone’s life is at stake.

What is a primary symptom of a hospital that’s unsafe? Let’s start with the obvious: unclean. Unclean looks like clutter, disarray, un-emptied trash cans (in all sizes), leftover food on tables (including waiting areas), stains on furniture, and much more.  Unclean can also look like soiled scrubs, uniforms, badges.

Unclean is unsafe.  Patients fall over clutter; dirty, dusty, soiled linens, or otherwise unclean patient rooms or bathrooms increase the risk of infection.

Another symptom of an unsafe hospital is noise. A noisy hospital, which they all are, implies some message or communication is being missed.

Some word not heard. Some patient not heard. Some misunderstanding occurring right now.

Noise is auditory clutter. It is disruptive to the healing process and causes responses that can be measured by increased blood pressure and heart rate. Its antithesis is auditory clarity, when every sound is meaningful and necessary and represents a well-working hospital.

Once broken down into its simplest components, keeping a patient safe is about action rather than non-action.  It is about being proactive rather than reactive.  It is about prevention rather than after-the-fact treatment or apologies.  It is more in-the-moment critical than after-the-fact HCAHPS or patient satisfaction scores can possibly indicate.

So we have to ask ourselves, why would we tolerate any aspect of “unsafe?”

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