December 17, 2019


Projections for healthcare industry trends in 2020 started to proliferate near the end of 2019 as attention turned to the new year. Reflecting on the Institute of Medicine’s (IOM) landmark 1999 report, “To Err Is Human: Building a Safer Health System,” some healthcare leaders said the report has raised awareness and led to many patient safety initiatives, yet much more work is needed to improve patient care.

The IOM—now the National Academy of Medicine—proposed several goals in 1999:

• reduce preventable errors by at least 50% within 5 years

• create a new federal agency to set national safety goals and track progress

• establish a nationwide, public mandatory reporting system for adverse events leading to death or serious injury

• develop robust safety systems in all healthcare organizations.

Authors of a 2018 HealthAffairs article say progress has been made over the past couple of decades, but they cite diagnostic errors, outpatient safety, and vulnerability of information technology systems as key concerns for the future. “Despite progress in hospital-acquired infections and medication safety, there remain substantial opportunities for improvement—far more than any individual organization can afford to test or adopt,” they say. “Progress in the prevention of patient harms such as pressure ulcers, deep venous thrombosis and embolism, and falls has been variable, even though some effective solutions are available.”


Creating the right culture

Some healthcare leaders have criticized chief executive officers (CEOs) for failing to make quality and safety their core mission. “I’m happy that the problem is now recognized,” Donald M. Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement, says in a Modern Healthcare article. “But I’m especially disappointed that quality improvement hasn’t risen to the strategic center of healthcare,” adds Dr Berwick, one of the IOM report’s authors.

During a keynote panel at the Becker’s Hospital Review CEO + CFO Roundtable in November, C-suite leaders from four hospital systems expressed concerns about challenges other than patient safety: the growing outpatient market, reimbursement, changing patient care models, recruitment and retention of top talent, and providing affordable healthcare. This is not to say that they’re unconcerned about patient safety, which is an inherent part of the challenges in their list. However, they placed greater emphasis on financial performance than on safety.

Dr Berwick and other safety experts see room for improvement in workplace cultures.

“Too many caregivers are too often subjected to disrespectful and demeaning behavior when they raise concerns about safety and quality,” says Mark Chassin, MD, FACP, MPP, MPH, president and CEO of the Joint Commission, in a Modern Healthcare commentary. “Such behaviors drive critical information about unsafe conditions underground, not to be discovered until patient harm results.”

Dr Chassin urges leaders to advocate for reporting of safety and quality concerns and to hold every caregiver accountable for following protocols, regardless of rank within the organization. He also notes that although the IOM report has raised awareness of safety concerns, problems persist—such as invasive procedures on the wrong patient or body part, which are estimated to occur about 45 times every week in the US.

“Leaders must face the reality that healthcare safety processes very often fail at rates of 50% or more,” he says. “Hand-hygiene compliance and handoff communication are two of the more conspicuous examples.”

Citing process improvement methods such as Lean, Six Sigma, and change management, Dr Chassin says these have worked well in other industries because they pinpoint the causes of persistent quality problems, and they are more effective than a “one-size-fits-all” best-practice approach. He would like to see healthcare leaders commit to a goal of “zero harm—meaning zero complications of care, zero injuries to caregivers, zero episodes of overuse, and zero missed opportunities to provide effective care.”

Putting safety first

Safe patient care is the core mission of all healthcare professionals, and it’s a theme in practically every OR Manager article. How can we help you achieve this goal? As a start, we asked our Editorial Advisory Board members to share their biggest challenges and concerns about patient care, and we will address many of these themes in the coming year (p 19). In this issue, we offer our annual update of Joint Commission standards (cover story) to help ensure compliance, as well as lessons learned in managing malignant hyperthermia and improving handoff communication.

We hope these and other articles will get you off to a good start in 2020. Happy New Year! ✥



Bates D W, Singh H. Two decades since To Err Is Human: An assessment of progress and emerging priorities in patient safety. HealthAffairs. Published online November 2018.

Chassin M. One-size-fits-all approach to patient safety improvement won’t get us to the ultimate goal—zero harm. Modern Healthcare. November 9, 2019.

Park A. What’s the future of the hospital? 4 healthcare executives on the biggest challenges facing healthcare in 2020. Becker’s Hospital Review. November 11, 2019.

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