Patient Perception of Safety Falling in Recent Research
Executive Summary
Some key indicators of patient safety are improving after previous declines. Patient perception of safety does not correlate with those improvements.
- Catheter-associated urinary tract infection rates are down.
- Some metrics are still recovering from pandemic levels.
- Perceptions of safety in hospitals fell 5.1%.
Despite improvements in some key metrics for patient safety, consumers do not report a corresponding confidence in their quality of care.
Press Ganey’s recent Safety in Healthcare 2024 report showed key declines in certain patient safety metrics, with catheter-associated urinary tract infection (CAUTI) rates down 11.46% more in 2023 than in 2019 and fall rates decreasing 2.67% during that same time period.
The report also shows lower incidences of central line-associated bloodstream infections (CLABSIs) and hospital-acquired pressure injuries (HAPIs) between 2022 and 2023. However, those figures still have not recovered to pre-pandemic levels. Patient perceptions of safety in healthcare do not necessarily reflect any growing confidence that would correlate with the improved metrics, the report suggests.
The Press Ganey report cites these key takeaways:
- The gap in patient perceptions of safety in inpatient and outpatient settings is now 2.5 times wider than pre-pandemic. While patients in medical practices and ambulatory settings felt substantially safer in 2023 (81.9%) compared to pre-pandemic levels (78.1%), perceptions of safety in hospitals fell 5.1%.
- Following record lows in 2021, workplace safety culture is increasing. Employee views of safety within their organization have risen 1.2% over the last two years, but nearly half still report low perceptions of safety culture.
- Reported assaults against nursing personnel jumped 5% year over year. In 2023, the rate of reported assaults against nurses increased to 2.71 per 100 nursing personnel, from 2.59 per 100 the previous year.
- Safety outcomes show continued momentum. The biggest improvement was seen in CAUTI rates, which are now better than pre-pandemic levels.
(The report is available online at https://bit.ly/3VQ5XSi.)
Research had suggested earlier that there is a strong connection between patient perceptions of safety and their likelihood to recommend the hospital or practice, says Tejal Gandhi, MPH, CPPS, chief safety and transformation officer with Press Ganey in Fort Worth, TX. On a five-point scale, if patients score safety at the maximum of five, their likelihood to recommend tends to be very high, she says. If they score it anything less than a five, their likelihood to recommend drops precipitously to the lowest percentile, she explains.
“It just shows how important that feeling of safety is to people. We had shown in past analyses that that big drop occurs even when you segment, but we always want to bring the equity lens to this work. When you segment and ask is it the same for men vs. women or Asian compared to white compared to Black, that big drop is pretty much the same for everyone,” Gandhi says. “Safety is foundational, so if you don’t feel safe, nothing else matters.”
In the latest research, Press Ganey looked at trends over time of patient perceptions of safety. They found that in the ambulatory setting, patient perceptions of safety from 2019 until 2023 actually increased during the pandemic. They are drifting down a bit but still are better than pre-pandemic numbers.
“However, on the inpatient side, patient perceptions of safety dropped during the pandemic and actually got to their lowest in 2022. They are maybe in a little bit of an uptick now but are definitely still lower than they were before the pandemic,” she says. “I thought that was pretty interesting that ambulatory improves, whereas inpatient went down, and you can understand people are maybe much more aware of risks in the hospital, and maybe the pandemic highlighted that for them. They’re much more in tune with anything that seems like it’s not quite right or makes them worry about safety on the inpatient side.”
That may be why that drop has occurred and has not quite recovered, she says. On the outpatient side, there is no clear explanation for why it improved during the pandemic, except for the fact that perhaps people were just happy to be able to get in at all during the pandemic, Gandhi says.
“What I often tell organizations as they start looking at this data is that the trends are here, but the question is why. We have to start digging in deeper to understand the why and ways to do that, or to start looking at patient comments to really understand what is it that caused them to feel unsafe,” she says. “Going to that next level of depth of understanding is really where we have to go as an industry to understand why patients don’t feel safe.”
Gandhi also notes that discussions of patient safety, and patient perceptions of safety, tend to focus only on physical harm, but emotional harm also should be considered.
“Even if patient perceptions don’t necessarily correlate with those hard physical outcomes, they are important because not feeling safe can lead to lack of trust, which can impact future care,” she says. “As shown in this likelihood to recommend, it can cause emotional harm in the moment. We should be studying that to understand what that connection is between not feeling safe and actual physical safety. Even if they’re not directly or strongly correlated, they both matter.”
Gandhi encourages all organizations to ask patients about their perceptions of safety. There has been a reticence to ask in the past for a number of reasons, including the idea that patients do not have a proper understanding of healthcare safety the way professionals do, she says. There also has been reluctance because organizations do not know what to do with the patient responses once they get them, she says.
“The first action item is we should be asking patients about safety, looking at comments to understand what they mean when they say they don’t feel safe. We should be leveraging patient voice and engaging patients in our safety and quality efforts,” Gandhi says. “We shouldn’t assume we know what will make patients feel safe. We should bring in patient voices and make sure that we are co-designing with patients to solve for some of these issues.”
There are a number of ways to try to bring that patient voice in, Gandhi says, such as focus groups and patient family advisory councils.
A key goal should be understanding what patients mean when they say they do not feel safe, Gandhi says.
“It can be things related to actions that they observe amongst their team members. If they see poor teamwork with their team, that’s something that makes them feel unsafe,” she says. “It may not be that every time that leads to a safety issue, but it could lead to safety issues, and certainly leads to loss of trust.”
Source
- Tejal Gandhi, MPH, CPPS, Chief Safety and Transformation Officer, Press Ganey, Fort Worth, TX. Email: [email protected].
Despite improvements in some key metrics for patient safety, consumers do not report a corresponding confidence in their quality of care.
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