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Do patients perceive healthcare’s gains in patient safety?

Hospitals have improved on key patient safety metrics, but whether patients perceive those improvements is a matter of receiving inpatient or outpatient care.

Patient safety has objectively improved since the pandemic, but do patients think so? Not so much, according to a new report from Press Ganey that found outpatients are far more likely to perceive patient safety than those receiving inpatient care.

Based on Press Ganey data, the Safety in Healthcare 2024 report showed key downswings in certain patient safety metrics. Catheter-associated urinary tract infection (CAUTI) rates were 11.46 percent lower in 2023 than in 2019, and fall rates decreased 2.67 percent during that same time period.

The report also showed lower incidences of central line-associated bloodstream infections (CLABSI) and hospital-acquired pressure injuries (HAPIs) between 2022 and 2023, although these rates have not yet reached pre-pandemic levels.

Still, despite these gains, not all patients have a good perception of the state of patient safety.

“While many aspects of safety are moving in the right direction, some measures continue to be of concern and highlight critical gaps that leaders should address,” Tejal Gandhi, MD, MPH, CPPS, the chief safety and transformation officer at Press Ganey, said in a statement.

“Healthcare organizations that do best on safety embrace a holistic approach, with safety as a core value grounded in both patient and employee experiences,” continued Gandhi. “In doing so, they can foster a culture of high reliability, drive stronger, more consistent, and equitable safety outcomes, and make progress toward the goal of zero harm.”

Perceptions of patient safety depend on where the patient received care, the report showed. Patients who received care on an outpatient basis were far more likely to report good perceptions of patient safety. In 2019, 78.8 percent of patients getting outpatient care agreed that staff protected safety; by 2023, that figure rose to 81.8 percent.

In contrast, folks receiving patients inside a hospital on an inpatient basis were less inclined to report good patient safety. In 2019, 73.5 percent agreed staff provides care in a safe manner compared to just 68.2 percent who agreed in 2023.

“Patients in hospitals are typically dealing with more serious conditions and more stressful situations, which can account for differences in their expectations of safety,” the report authors wrote. “While a gap between inpatient and outpatient settings might be expected, the diverging trend should prompt a closer look at the data.”

When looking at free-text patient experience data, the researcher saw that inpatients were more likely to express concerns about staff skills or issues like forgetfulness or making mistakes.

These findings should prompt a second look at staff training programs, especially considering the correlation between perceptions of patient safety and the “likelihood to recommend” metric most hospitals use to measure patient experience. Right now, 84 percent of patients reporting strong perceptions of patient safety are also likely to recommend a facility, compared to just 34 percent among those with poor perceptions of safety.

Most healthcare leaders agree that improving patient safety—which Press Ganey did show hospitals have done successfully—will require an overall culture of safety in a facility. A culture of safety means more than just moving the needle on patient safety metrics.

“When healthcare workers feel confident that their organization delivers safe care—as well as feel safe themselves—it fosters a positive work environment, leading to higher morale, employee engagement, and retention,” the report authors explained.

Employee perceptions of patient safety are improving, the report revealed. Scores for overall patient safety culture are up from 2022, rising from 3.99 on a five-point scale to 4.01 in 2023. There were big improvements in perceptions in the Resources & Teamwork domain (from 3.68 to 3.74) and adequate unit staffing, rising from 3.14 to 3.30.

Still, the Press Ganey authors stressed that there’s a lot of work to do in improving a culture of safety, pointing out that rating below a 4 in any of the domains is less than desirable.

Overall, 48.5 percent of employees still have a low perception of safety culture, with some of the slimmest improvements being in perceptions of prevention and reporting. This comes as most safety culture best practices tout a need for judgement-free mistake reporting.

Of course, a culture of safety doesn’t just consider patient safety. Particularly since the pandemic, healthcare workers have had to contend with their own safety in the workplace.

Employee safety is only getting worse, with the Press Ganey report showing a 5 percent increase year over year (YoY) in reported assaults against nursing personnel. This could indicate a growing willingness to report assaults, the report authors considered, but the number of assaults totaled 16,975 in 2023.

Even still, 80 percent of provider respondents agreed or strongly agreed that their organizations cared about employee safety.

“Addressing workplace violence—as well as general workforce safety, including preventing back injuries, needlesticks, and slips/falls—is a critical need,” the report authors explained. “Organizations must champion a culture of transparent and thorough reporting as well as reliably implement best practices to keep all employees safe from harm.”

As healthcare organizations continue to move through their patient safety journeys, it will be important to emphasize safety as a core value, integrated approaches, and employee and patient experience data. Those efforts, coupled with using AI tools to supplement key strategies and promote transparency, will be key, the report concluded.

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