A Landmark Patient-Safety Action Plan, and Family Caregiving as a Key Piece

The work was exciting from the time of the committee’s formation and stayed that way throughout the process.

In May 2018, the Institute for Healthcare Improvement convened the National Steering Committee (NSC) for Patient Safety as a collaboration among 27 national organizations committed to advancing safety. From the start, I was enthused about the opportunity to serve on the NSC and join other experts in rolling up our sleeves and getting to work on such an important issue. And now, it’s all the more exciting to have the fruit of our work released out into the world.

Last month brought the release of “Safer Together: A National Action Plan to Advance Patient Safety,” the NSC’s landmark report and roadmap intended to provide health systems with renewed momentum and clearer direction for eliminating preventable medical harm. Importantly, the action plan offers a chance to take a giant leap forward in the area of patient safety after some two decades since the publication of the Institute of Medicine’s seminal report, “To Err Is Human: Building a Safer Health System.” Catalyzing our initiative was a general awareness in the field of “project fatigue”—that is, a lack of fresh attention and new ideas. Much obviously has happened in health care over the last 20 years, and so we were long overdue for a fresh look at the issue.

Of course, throughout the process, I’ve been excited to be a part of a group doing important work—one that would advance and reinvigorate the field of patient safety. But from the beginning, I’ve also been excited for another reason. I mentioned that much has happened in various health care fields during the years since the Institute of Medicine report; in fact, my very participation on the committee represented tremendous progress on an issue about which I’m so passionate, one that has been a core part of my life’s work: family caregiving.

Providing the base of the action plan are four foundational areas: Culture, Leadership, and Governance; Patient and Family Engagement; Workforce Safety; and Learning System. Having worked for much of my career to support family caregivers and even change the very way the health care system thinks of them, I served on the Patient and Family Engagement subcommittee. If you want to know one area of health care and long-term services and supports that has undergone a seismic philosophical shift in the last 20 years (just in the last decade, really), look no further than family engagement. Thus, the mere creation of this subcommittee spoke volumes from day one of the National Steering Committee’s work: 20 years after the publication of the National Institute of Medicine report, family caregiving was now understood to be a central piece of the solution in improving the safety of patients.

Recommendations that Resonate

As the creation of our subcommittee signaled, the care recipient’s family (or friends, also encompassed in the term family caregiver) plays a prominent role in the National Action Plan, with a full five of the 17 Recommendations to Advance Patient Safety coming out of our Patient and Family Engagement work:

  • Establish competencies for all health care professionals for the engagement of patients, families, and care partners.
  • Engage patients, families, and care partners in the co-production of care.
  • Include patients, families, and care partners in leadership, governance, and safety and improvement efforts.
  • Ensure equitable engagement for all patients, families, and care partners.
  • Promote a culture of trust and respect for patients, families, and care partners.

When I look at those recommendations, I see many notable manifestations of the work of family caregiving experts and advocates, including AARP and the AARP Public Policy Institute.  For one, the very notion of family caregivers being acknowledged as care-team partners right along with health care professionals—a notion underpinning all of those recommendations—lies at the heart of the Caregiver Advise Record Enable (CARE) Act,  state legislation that responds to the needs of family caregivers that we uncovered in our Home Alone research. The legislation, now law in 43 states and counting, calls for health care professionals to identify and properly instruct family caregivers prior to individuals being released from the hospital. This approach is crucial to care recipients’ safety, particularly with family caregivers now being assigned complex-care tasks that were once the exclusive domain of trained health care professionals.

The NSC’s work is also in sync with another concept AARP and its Public Policy Institute champion: person-centered care, although we urge that this concept be explicitly expanded to refer to person- and-family-centered care.  We are working to ensure that patients and families “experience life-long journeys across the entire continuum of care,” that family caregivers offer “unique and essential perspectives on care delivery,” and that their insights are “critical for creating safer care.”

Real Work Starts Now

Of course, Patient and Family Engagement was but one of four areas that provides the foundation of the National Action Plan. Each of the areas are equally important to the vision of creating a coordinated approach to patient safety, and the COVID-19 pandemic has only underlined the urgent need for rapid advance in this area. To give just one pandemic-related example, the plan’s foundational area of Workforce Safety has obvious implications as 2020’s health-care workers perform the duties we have all acknowledged as heroic. We are heavily involved in the issue via the Future of Nursing: Campaign for Action—an initiative of AARP Foundation, AARP, and the Robert Wood Johnson Foundation.

Meantime, suffice it to say that I couldn’t be more proud of playing a role in the NSC’s National Action Plan, the product of two years’ work. Such a vehicle for reinvigorating and advancing patient safety was long overdue. Now, with a powerful plan in hand, it’s time to use it. It’s time to take action.

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