YouTube Video: https://www.youtube.com/watch?v=BJljVc6rntk
Originally Published: Nov 28, 2023
Join Dr. Jay Bhatt in an insightful session as he unveils the second edition of "Patient Safety: A Case-based Innovative Playbook for Safer Care" a groundbreaking book designed to revolutionize healthcare systems. Delve into real-life clinical case studies, exploring a spectrum of medical errors. Gain actionable insights applicable across diverse settings for creating a safer healthcare environment.
Don't miss this opportunity to engage with Dr. Jay Bhatt and explore transformative ideas shaping the future of healthcare.
Jay Bhatt, MD, Primary Care Internist, Adjunct Faculty, Professor, University of Illinois Chicago School of Public Health, Managing Director, Deloitte
Megan Antonelli, Chief Executive Officer, HealthIMPACT
GMT20231114-221701_Recording
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Megan Antonelli: Hi, everybody. Welcome to Health Impact. This is Megan Antonelli, and I am so excited to be here with an old friend. I think we met back in Chicago at a Health Impact [00:00:36] Midwest years and years ago. Dr. Jay Bhatt. Jay is a practicing physician, primary care, and a public health innovator and instructor at the University of Illinois at the Chicago School of Public Health.
And he has recently co authored a book with Dr. Abha Agrawal. We're here to talk to him about that, as well as his work in healthcare innovation and what he's seeing in trends. Hi, Jay.
Dr. Jay Bhatt: Hi, Megan. It's wonderful to be with you. And I really appreciate the time we have to talk about this really important issue of patient safety.
And thanks for lifting up this conversation. [00:01:12]
Megan Antonelli: Yeah, it's funny. I mean, when you think back in terms of all of the innovation and work that's been done in this space, it really all started with patient safety, right? I mean,
Dr. Jay Bhatt: Yeah, it's patient safety has been tried and true over the years, and I think COVID illuminated that it's even more important.
And, there are more tools now than we had before to address it. And we've made progress, but not Yeah. Nearly the progress we need to make on this issue and the work of experts over the last two decades has shown that the problems medical errors, patient safety as a [00:01:48] challenge is continuing to be an important issue and it's the opportunity of well intentioned people trying to do the right thing, but our systems are not reliable and There is ways that we can approach health both quality and safety from a system view that can help us lead to better health outcomes and minimize adverse events.
Megan Antonelli: Yeah. So tell us a little bit about the book. I know it's the second edition of Patient Safety, a case based innovative playbook for safer care. Correct? So tell us a little bit about the book and then [00:02:24] kind of, what the aim behind it is. Sure.
Dr. Jay Bhatt: I'm honored to be an editor on this book with my colleague and friend, Dr.
Aba Agarwal. She is been a medical executive for Many years in New York and Chicago and as an informaticist and very much driven by improving quality and safety. And so she helped pull together the first edition. We built on that, this edition, that edition with the second one that we're just releasing.
And the book aims to serve as a playbook and guide for the creation of a safer health care system. In this environment and moment, building [00:03:00] on the new technologies, tools, building on our knowledge and quality and safety and building on what we learned through the pandemic. And this book would not have been possible and wouldn't be available today if it wasn't for the expertise, the commitment, the work of so many authors of the chapters that reflect the issues that are important to patient safety today.
And so I'm just so grateful to my colleagues and friends that have contributed to the second edition and offered their views on these are from health care leaders, accomplished practitioners and experts in patient safety. [00:03:36] And so we talk about some of the same issues that are tried and true. The National Patient Safety Goals that have been illuminated by the Joint Commission and others, the Agency for Health Care Quality Research, the Institute for Health Care Improvement, the National Foundation for Patient Safety and.
Many others, but what this book provides a new vision of patient safety, in this decade to come and what changes need to fall into place between now and the next decade. We have this future of high quality, affordable, equitable care [00:04:12] realized, and so we offer this as a case based approach because we want the community to learn from these cases in which you can see the opportunities to make different decisions or learn from what unfortunately may have happened in the course of adverse events.
And we look at the most common types of medical errors and to help readers learn the key clinical organizational system issues in patient safety. And do you remember Megan in the, in the late nineties to air is human. It's a report from the National Academy of Medicine, Institute of Medicine, [00:04:48] that really spoke to the number of medical lawyers, nearly 100, 000 a year that we have in this country.
And so we've made, again, progress, but a lot more to do. And if we look across the world the, that number is at nearly 3 million.
Megan Antonelli: Yeah, no, it is. And I think the approach of a case based, having the examples, having, learning from the mistakes that are made, right? I mean, or, sort of the various situations.
Are there some examples in there that you think are, particularly notable?
Dr. Jay Bhatt: Sure. I, [00:05:24] so we break the book up into several sections. One, the foundation, which is high reliability, health equity, which, is a key aspect of patient safety quality and equity are two sides of the same coin.
You can't have one without the other, and in order to have high quality health care, health equity has to be a part of it, and it's certainly been further illuminated through the course of the last several years. The culture of safety is foundational. We talk about through the view of the work of the Hospital Improvement Innovation Network nationally, and as I was former Chief Medical Officer of the American Hospital Association, led the nation's [00:06:00] largest Hospital Improvement Innovation Network with 34 states and nearly 1, 700 hospitals to reduce adverse events by 20%, readmissions by 12%, to talk about some of the lessons from that.
Human factors in patient safety, again a view of reliability, but builds on that and I think so important. About design and intention and how we help. Minimize human error, and COVID 19 and patient safety we talk about as well. And then you talk about a number of different traditional concepts of transitions, teamwork and communication, patient identification, the use of the [00:06:36] electronic health record as a tool to help advance patient safety, and then, the myriad of clinical ethics issues that emerge.
In the work of quality and safety, and then we talk about clinical scenarios that are common errors that we've seen over the years, medication error, wrong site surgery, hospital card infections, which are more, the adverse events falls, diagnostic error, which is, emerges a really important issue over the course of the years, reframe as diagnostic excellence, and then opioid safety and then we go through special considerations through various disciplines in medicine and what patient safety looks like in pediatrics or anesthesia [00:07:12] or in mental health or outpatient care and emergency department.
And then also give an international view of this, what are the issues globally around patient safety? And then we talk about kind of the moral injury and communication and resolution as organizational issues. To address. So, really excited about the examples and the cases that come through here but the bottom line is, there's something to learn from each case that you can apply in your day to day practice, and this is also a great resource for educators.
They're trying to illustrate and teach around [00:07:48] quality and safety. Yeah.
Megan Antonelli: Well, you talk a little bit about in terms of the equity and patient safety and how they're two sides of, the same coin and stuff. And I think nothing was more apparent during the pandemic and so much was learned from that.
Are there some specifics in terms takeaways? What organizations can do? I mean, obviously, there's that culture of equity and the culture of patient safety and how do you make sure that they're both, kind of aligned to support each other?
Dr. Jay Bhatt: yEah, one, what we've seen been effective is a credible, measurable strategy for health equity that's integrated across the organization.
And if we just [00:08:24] take quality and safety, the focus of this book, looking at approaches like asking questions, what is the difference between Men and women when it comes to diabetes readmissions. And that data largely is available. And so one organization had a 10 percent difference. Women were getting readmitted more than men for diabetes.
And so then you dig into the various reasons, try to isolate from them, interrogate your data, and then have a plan for intervention. And reliability and teaching approaches and consistency and then incentivizing it [00:09:00] across the organization at an enterprise level and recognizing and celebrating it.
And so with that, over three years, the number went to zero. When we talk about we can get to zero, a million transfusions without a mismatch or three years without a catheter based infection. Those are inequity zero as possible as well. The zero gaps zero health gaps. And so that's one example.
The other is the approach to, looking at your population and the notion of observed versus expected ratios and what is expected of the population and community, the dominant population versus the observed of the. Population group segment that's [00:09:36] marginalized historically, and you could cut your metrics that way and see the other is longitudinal view of data over several years, as opposed to just one year, because you can see that, , consistency with treatment on medicines may drop off after a year in certain populations.
So those are some, opportunities, but it starts with. A strategy, a plan, and consistently asking the question and thinking about our sexual orientation, gender identity, and racial, ethnic minority data. Then I would say the other thing that came up is [00:10:12] language. Some places have now incorporated translation, language translation into their safety huddle.
So that you're also engaging in a conversation about are we supporting people who speak different languages effectively. So that we're minimizing adverse events and error.
Megan Antonelli: Right, which of course is becoming a little bit easier and more possible with some of the technology that's out there. So a lot of our audience is technology focused and innovation focused.
And so I think it's interesting that, obviously patient safety, which has been sort of the bellwether topic and an initiative [00:10:48] around innovation and technology implementation for how you, for the, for how you justify the. The cost and investment in that space. But of course as the time goes on, some of the innovations have maybe had less impact than others.
What are your thoughts on kind of maybe where some of the original technologies are in terms of doing their job with patient safety, but also let's also think I'd love to hear your thoughts on some of the new technologies and what their role like AI will be in either helping or what we need to worry about with respect to.
Equity and patient [00:11:24] safety for either of those.
Dr. Jay Bhatt: And, I think that there are many instances in which low tech tools can help address patient safety. One of the initiatives I was proud to be a part of was the Age Friendly Health Systems Initiative launched by the John A. Hartford Foundation, Institute for Healthcare Improvement, Catholic Health Association, American Hospital Association, which now is in over 3, 500 sites of care.
This model, the 4Ms where you look at the issues of what matters to patients and their families. Patient family preferences, and that's really the anchor, and then medication management, mobility, and mentation, and all four of those have to be deployed as a [00:12:00] bundle, and one of the interesting stories heard from one organization was that, they were seeing dehydration and decline in older adults on a unit, and one of the challenges was that this patients couldn't actually drink from their jug or their cup effectively to hydrate.
And so as a result, we're then having delirium because of the dehydration. And so what had an outcome that wasn't the best. And so by understanding that and using a different kind of [00:12:36] approach with a straw and a jug and making it easier for them to have hydration, reduced delirium by a significant percentage.
And so that is a low tech way. The other is our EHRs, with order sets and alerts. Those are all ways that we've been using it. Remote monitoring. The other thing that, that we think about is low value alerts, for organizations to evaluate what are high value alerts versus low value alerts and getting rid of low value alerts gives time back.
And when you ask patients what quality means for them, and we learned this from. Anna Rundle one of our [00:13:12] pioneer systems in age friendly, in the age friendly health system movement, was that it was time back for patients to do the things that mattered to them and for people that depended and for those that depended on them.
So, I think there's a lot of Work that we can do using existing technologies from digital to remote to things that offer alerts to even the procedures that are technology driven, we're seeing a more use of noninvasive approaches to address. Conditions, even continuous glucose monitoring, which is such an important area that's not covered by [00:13:48] a number of insurance providers, both public and commercial.
So that's Things that we've done in the past and here over the last several years that I've seen make a difference. The issue of AI has advanced patient safety by, helping interrogate data to produce insights, improve decision making, and be able to predict where to intervene and prioritize.
So, predicting substance deterioration, error detection, stratifying patients and managing You know, the use of medications. Those are all ways that AIs can be used. And [00:14:24] predictive AI, different than generative AI. Generative AI I don't know that it's ready for prime time clinically, but can help us around summarizing and inquiring large swaths of data to identify test results or other key areas or summarize, what the current state of condition is in the continuum of treatment, a diagnosis and treatment for a patient.
Prior authorization. Those are some administrative burdens that are impacting, workforce well being is another one. The other is not imaging, where we've seen AI play an important role and try to identify[00:15:00] nodules in the lung or other cancers early on that can be intervened on. So, early warning signs,
Megan Antonelli: yeah, and I think, I mean, I think that's an important distinction in terms of the predictive AI versus generative AI and that the predictive AI, aims, can potentially reduce some time and burden and time to diagnosis and things like that. But if anything, create, you hopefully create redundancy to avoid error of missed diagnosis to some degree, whereas the generative AI isn't really ready for prime time with respect to clinical, so while we can sort of cite and [00:15:36] see how errors could be presented if generative AI Is the tool we're talking about, but what about on the equity side?
I know that might not be a patient safety discussion, but have you in your work now and are you working on things with respect to AI and equity and the ethics initiatives around that?
Dr. Jay Bhatt: Yeah, I think that there's the important of trustworthy and ethical AI and technology.
And so having governance, monitoring testing of algorithms, we know that. There's data evidence that suggests that there's bias in clinical algorithms that are embedded in AI. And so I [00:16:12] think this is really an important area. That being said, AI also has the opportunity to help address health inequities by helping identify high risk individuals or when, people's risk is dynamic.
And so, understanding the combination of what needs might be most impacted and needed by patients from a social needs standpoint as well. And then you have community health navigators, care navigators, intervene on that and similar warning signs, early detection. And then also being able to offer technology that allows [00:16:48] behavior change and decision making and helping historically vulnerable underserved communities.
Be able to access better health, we also have to be mindful of, diagnostics that aren't, meeting the needs of people of color, for example, the pulse ox, had readings that may have been inaccurate. , for certain populations, we also, see that there are ways to use virtual and digital tools to help people manage their health.
But I also think from a mental health standpoint, it can be important, but we've got to be mindful of some of the bias and [00:17:24] then addressing misinformation and disinformation, that may be part of it. And then the last thing I'll say is, the point of view , artificial intelligence is an enabler and it will enhance the work you do.
And so those that know how to understand how to use it and build capability and understanding with it, will have an advantage in order to. Be able to
Megan Antonelli: address them. Yeah, I mean, I think, when we've done, lots of work and research around social determinants of health and been talking about it for so long, but it's such a, there's so much data and so much information to bring in that at least, at some point when they, when we're able to really leverage AI to, bring in that [00:18:00] information to make decisions.
decisions or help with decisions and help identify potential risks, then we'll be able to actually realize the power of that data. So you sit in a very unique place in terms of practicing, but also teaching and then working, even, often with employers and with many different organizations within healthcare.
And so I'd love your perspective, especially kind of going back from when, American Hospital Association to now where. tHere's been a lot of change, but the pandemic certainly brought forward the importance of public health, right? And where that fits [00:18:36] in. And I think even with patient safety, it's an interesting discussion because sometimes it does hit on that, sort of public health discussion versus, everyday practice and where a hospital is making decisions.
Where do you think we are in terms of That intersection of and that interplay between public health and health care. And, have we come far enough and how much further do we have to go?
Dr. Jay Bhatt: I think my view is that we've made some progress or good examples of how the community health needs assessment is being used as a convening tool and an intelligence for a community health strategy to address the needs and co create, needs of a [00:19:12] community and co create with the community. I think, there were some great bright spots in terms of how healthcare and public health work together during COVID. I think we've got to scale an approach instead of approaches for public health, healthcare delivery, and community based organizations to work together and care models that incorporate Those collaborations and then have a payment model that supports it.
So we're seeing some deployment, various models that are being tested that may be able to do that. And I think there's a renewed sense of, accelerating this work, you may have seen Kaiser Permanente launched a collaborative with a number of associations called the Common Health Coalition [00:19:48] that is really focused on exactly this the intersection between public health, healthcare delivery, and community based organizations to advance health in America.
So, I'm really excited about a number of different efforts in this arena, and we're seeing some regulatory tailwinds from the Joint Commission Identifying Health Equity as a National Patient Safety Goal, the NCQA Accreditation for Health Equity for Payers, to the work around clinical trial diversity in government and across the industry, and the work of new care models that are incorporating equity, and then population specific kind of products to serve the [00:20:24] LGBTQIA plus population or black women or Latino community and diabetes.
So I think all of those require, collaboration. We know the health equity is everybody's business and that it's not a side gig or side hustle. But that it's got to be thought about within the strategic operational financial work and most importantly, we're doing quality and safety so that we deliver the highest quality, affordable, equitable care to our patients, families, and
Megan Antonelli: communities.
Absolutely. Well, that is where we want to be for sure. And you're doing a lot of work in that space to make it happen. So thank you [00:21:00] so much for your time. Tell us again where we can get the book and the title.
Dr. Jay Bhatt: Thank you, Megan. The book we're really excited about it. Aba and I spent several years pulling together.
You can find it on Amazon. It's a title is Patient Safety, a case based innovative playbook for safer care. And I know that, the first edition was in libraries around the country and world, and we hope that this one will be as well published
Megan Antonelli: by Springer. Yes, no doubt. Well, thanks again.
It's always a pleasure to talk to you. Hopefully, we'll see you soon at a Health Impact or [00:21:36] maybe at Node Health's Digital Medicine Conference. And keep it up, and I look forward to seeing you. to getting the book, seeing the book and reading it and then sharing more with our audience.
Dr. Jay Bhatt: Thanks Megan, I really appreciate your leadership and work in the space and all that you're doing with Node Health and Health Impact and look forward to seeing you in those venues. Thank you. [00:22:12]