A Common, if Not Stunning, Question
Several times recently clinical leaders have posed the following question to Pascal leadership: “What is the relevance of your patient safety work for risk management?”
In short, what is the relationship between using the VPS solution to identify and reduce harm in patient safety and risk management? How can Pascal claim that using VPS serves to integrate these functions in a complementary way both strategically and tactically?
To answer these questions and more, we will cover the underlying problem in this blog and the solution in next month’s blog.
First of all, the very question exposes in sharp relief a problem from which healthcare has suffered for years: patient safety and risk management operate in separate organizational silos and have different purposes (practically), different processes, and different goals.
The reality is that silos are inevitable when purposes, processes, and goals are so different.
The good news is that these problems are addressable but, first, we need to unpack the problem further – starting with data. And, as this blog will foreshadow for the next blog, the solution also starts with data as we will see next month.
Safety & Risk: Separated by Uncommon Data
The reality is that patient safety and risk management functions share no common foundation of data.
The data on which patient safety relies is a combination of voluntary event reporting data, largely used for operations, and claims-based PSI-90 data, largely used for reimbursement and analytics.
On the other hand, risk management is driven by litigation data and, more specifically, lawsuits themselves and the need to reactively managed them when they too often arrive having never been identified as potentially compensable events (PCEs). To be clear, some health systems are better than others, with some achieving visibility on a majority of lawsuits before being served. However, Pascal estimates that most hospitals have visibility on less than 25% of the lawsuits before being filed.
Safety & Risk: Separated by Uncommon Time
Moreover, not only do patient safety and risk management use different sources of data, but they also are generally operating at different temporal stages. Patient safety works, for the most part, to keep patients safe while in the hospital with poor data. Risk management works, for the most part, after the patient leaves the hospital with lawsuit data to minimize the legal, financial, and reputational impact of a bad litigation outcome.
Patient safety has poor visibility on preventable patient harm, based on its over-weighted reliance on event reporting data, while risk management typically gets involved ex post facto without the data and tools to meaningfully measure and avoid preventable risk.
With respect to the patient’s episode of care, these two functions are generally separated by time.
Safety & Risk: Separated by Uncommon Systems
Based on the two aspects of the problem just covered – data and time – it’s unsurprising that patient safety and risk management use two different workflows.
Patient safety generally relies on software portals to report events. The idea is that, if a “culture of safety” is positive, clinicians and staff will report patient safety events. While well intended and resourced for over two decades, the literature shows that even very positive cultures (as measured with scientifically validated culture surveys) identify approximately 5% of patient harm.
For its part, risk management generally relies on claims management software. The idea is that, once a lawsuit is on the books, a risk management team will manage that case until its conclusion.
These two workflows are not only occurring at different time frames along the journey of a patient and her family but they also are addressing very different needs and, as a result, reflect very different requirements for “success.”
Is There Hope?
Yes, there is hope. When a health system begins to measure all harm all the time for all patients with AE Outcomes data (i.e. clinically validated adverse event outcomes based on real-time EHR data), that health system collapses the silos with significant clinical, financial, legal, regulatory, and experience benefits.
One more thing: why do we call the overall question above “stunning”? It is because both patient safety and risk management have as their core function avoiding preventable harm that results in suffering of patients and their families.
We will cover why and how patient safety and risk management, notwithstanding different mandates, can collaborate to accomplish just that in next month’s blog.