Improving Patient Safety: Key Challenges and Solutions in Healthcare

Ongoing challenges in healthcare staffing and morale

ECRI is an independent, nonprofit organization focused on improving the safety, quality, and cost-effectiveness of care across all healthcare settings. In their 2024 report, they determined the number one safety concern to be transitioning newly trained clinicians from education into practice⁽⁵⁾. The COVID-19 pandemic continues to cast its shadow over the emerging healthcare workforce as many new staff had much of their training hindered by the pandemic. ECRI found that this lack of preparation not only impacts patient safety due to clinicians’ practice, but that new clinicians are much less likely than experienced staff to raise patient safety concerns. Recommendations to meet this challenge include a total systems approach that provides new clinicians with an intense mentorship that includes diversity, equity, and inclusion (DEI) programs. Boston-Leary, et al (2024) describe the impact of the ongoing nursing shortage on patient safety. The shortage of nursing staff leads to missed nursing care and contributes to poor patient outcomes and even increased risk of death ⁽¹⁾.

Medication Safety

Another patient safety concern from the ECRI report is work-arounds in barcode medication administration systems (BCMAs). Many clinicians circumvent established procedures when a barcode is difficult to scan or when a medication has not been added to the system. ECRI refers to several resources to combat these issues, including multidisciplinary teams to review practices and ensure that clinicians are given the proper training and resources to fully employ the system, empowering patients and families to know about the system and ask why it is not being used, and engaging clinicians in reporting issues with the systems while ensuring they realize the importance of this basic safety mechanism. 

The Joint Commission, a not-for-profit organization that “works to improve the quality and safety of patient care in healthcare, ⁽³⁾” reflects this concern in their 2024 patient safety goals. They state all medications should be labeled where and when they are prepared, helping ensure that the right medication is delivered to the right patient. In addition, every patient should be identified by at least two patient identifiers (such a name and date of birth), to ensure that each patient receives the correct medication.

HealthCare Equity 

Ensuring health equity is a patient safety concern echoed by both the Joint Commission and the ECRI. Health equity involves removing barriers that populations encounter in accessing health care. According to the ECRI, 2.2 million women of reproductive age in the US live in maternity care “deserts” which represent 1,000 counties with “no hospitals providing obstetric care, no birth centers, no OB-GYN providers, and no certified nurse midwives. ⁽⁵⁾” The US maternal mortality rate is currently ranked highest among affluent countries. Eliminating maternity deserts will necessitate changes in public policy. In addition, healthcare staff must be trained to respond to obstetric and neonatal emergencies and be empowered to raise concerns in these areas.

Another aspect of health care equity is providing adequate care for people with physical and intellectual disabilities. Per the ECRI report, people with disabilities, “including difficulties related to mobility, cognition, hearing, vision, independent living, and self-care are more likely to experience higher rates of adverse health conditions, including COVID-19, mental health concerns, and abuse, violence and neglect ⁽⁵⁾.” Patients with disabilities face multiple barriers to accessing care, including physical, communication, transportation, and policy. As a result, 1:4 disabled adults do not have a PCP and 1:5 have not had a routine check up in the last year. Recommendations for action include ensuring compliance with all aspects of the Americans with Disabilities Act (ADA), disseminating disability-competent healthcare values, engaging the patient and family in a shared care plan, and training staff in the use of equipment for patients with disabilities. 

A Success Story

The Leapfrog Group grades hospitals yearly from A to F on how they perform on patient safety. St. Bernard Hospital in Chicago accomplished the almost unprecedented task of raising their grade from an “F” to an “A” in only two years ⁽²⁾. The facility began their quest by appointing a Quality and Safety officer, who quickly recognized the safety issues in the hospital. One problem was unsafe medication administration, as staff, for several reasons, were not using the bar code medication administration system properly. The hospital quickly revamped their equipment, retrained their nurses, and improved their Wi-Fi, one of the barriers to the system working well. They were then able to improve their rate of BCMA use to around 98%. 

The facility also focused on hand hygiene by implementing an electronic hand monitoring system. With this system, they increased the rate of staff compliance with hand hygiene to 92%, with a goal of 95%, within a year. Most importantly, St. Bernard strove to establish a just and safe culture at the hospital, where staff would feel empowered to raise safety concerns and where management would address those concerns without retaliating against the workers. The hospital also improved their staffing and infection prevention systems. 

Although patient safety continues to be a challenge in 2024, the St. Bernard Hospital story illustrates the potential for every healthcare facility to make improvements in their patient safety scores. As the US healthcare organizations continue to recover from the COVID-19 Pandemic, government and healthcare agencies must work in tandem to make the system one where staff are supported, and patients can receive care in a safe and equitable way.