Although there has been significant improvement in overall patient safety in the in-patient hospital setting in the last 15 years, the scope of the problem has widened outside the hospital walls and the definition of patient harm has expanded. There’s still much work to be done, according to a report recently released by an expert panel convened by the National Patient Safety Foundation.

“In the late 1990s, we weren’t even talking about patient safety the same way; we didn’t have to tools or the infrastructure,” said Tejal Gandhi, M.D., president and CEO of the National Patient Safety Foundation. “Now we have people focusing on it, more science and more education. What our report does is renew the call to action.”

The report, Free from Harm — Accelerating Patient Safety Improvement Fifteen Years after To Err is Human, reflects on progress toward improving patient safety, and a “lessening intensity of focus on the issue,” since the publication of the Institute of Medicine’s landmark report To Err is Human.

The crux of the report is that what’s needed is a total systems approach and a culture of safety. To that end, eight recommendations are given.

1. Ensure that leaders establish and sustain a safety culture

2. Create centralized and coordinated oversight of patient safety

3. Create a common set of safety metrics that reflect meaningful outcomes

4. Increase funding for research in patient safety and implementation science

5. Address safety across the entire care continuum

6. Support the health care workforce

7. Partner with patients and families for the safest care

8. Ensure that technology is safe and optimized to improve patient safety

The No. 1 recommendation, getting leadership to establish, and keep alive, a culture of safety will require convincing health care leaders that there really is a return on investment tied to improving safety.

“We really need to make a case for it,” Gandhi said, noting that patient survey data and other proof points can be used to bring patient harm issues to the forefront again, after some complacency and new priorities like a focus on health care costs put safety in the backseat.

For health system leaders to implement the recommendations, Gandhi foresees the NPSF creating “a playbook that provides some of the ways you can create a comprehensive action plan. It’ll also say, ‘here’s some of the pitfalls, and ways they can be avoided.’ In that way, we hope this report will be one piece of a jump start in a focus on patient harm.”

The report says the comprehensive nature of the problem needs to be dealt with by coordinating efforts in the hospital, in ambulatory care facilities, in doctors' offices, pharmacy and in the home; wherever care is administered, safety prevention and measurement should exist.

“Most of the research has been in the hospital setting, there’s not a lot of data about the problems in these other settings. But most of patient care is given outside the institution,” Gandhi said. “We need to see whether we can build safety into existing infrastructures and be more creative about how we use data to drive improvement.”

Gandhi said rather than looking at the problem through claims data alone, data like patient satisfaction surveys and electronic health records and myriad new data sources must be tapped to get a clearer picture of patient harm.

The report also points out that the focus of safety management needs to grow beyond issues of mortality to look at morbidity and loss of quality of life due to patient harm.

“There’s so much attention on deaths,” Gandhi said. “But cutting off the wrong leg won’t kill a patient, but it’s certainly a major example of patient harm.”