The IOM and 6 Aims for healthcare

The Institute of Medicine describes the characteristics of 21st century healthcare under six headings: Safe, Effective, Patient Centered, Timely, Efficient and Equitable. In this 6 part discussion, the topics will be taken in due course to stimulate input on this important work.

Aim #1: Care should be SAFE: Patients should not be harmed by the care that is intended to help them.

Since the publication of "To Err is Human," in 1999 we have witnessed important advances in safe practices in healthcare. Although predominantly driven by hospital and other institutional care settings, the changes are important in all regards. The initial work on improving safe medication practices recognized the great good and potential harm that highly toxic/effective chemical can have on the human body. Other focus areas include: falls, wrong site surgery, and the like. In most all cases, we recognize that reporting of unsafe practices and 'bad outcomes' is grossly understated. Again, likely this is part of our human nature to fail on reporting negative outcomes and to miss identify contributing factors to unsafe processes and results. Organizations such as JCAHO, NQF and the Leapfrog group have continued to aggressively suggest tactics and areas of further safe practices. Yet, I am struck by the simpler and most difficult tactic: creating a safety culture.

Over 20 years ago, a good friend, Bob Slonski, impressed upon me the over-arching importance of a safety culture as the means to improved safety in the workplace. The business world, especially manufacturing, learned the importance of culture on outcomes long ago. A safety driven workplace improves production, reduces waste, lessens lost work-days, and cuts worker compensation costs dramatically. It also reminds the worker that they are important and so is their good health. Makes great business sense.

I'm reminded by Dr. Brenda Rooney that 'culture eats strategy for lunch', yet, the corollary is also true, culture (well directed, nurtured and effective) can propel strategy beyond the dreams of most leaders. How then, can we most effectively improve patient safety using culture?