Advancing patient safety worldwide: Q&A with Drs. Tim McDonald and Darren Kilroy

September 17, 2023 Dr. Tim McDonald and Dr. Darren Kilroy

Each year, the World Health Organization (WHO) observes World Patient Safety Day to encourage global solidarity and concerted action by all countries and international partners working to improve patient safety. In support of this year’s WHO-identified focus, engaging patients to improve care outcomes, we are exploring patient safety from the perspective of patient and family engagement and how healthcare teams can shift perspectives to better care.

We spoke with two leading healthcare executives and safety specialists — former NHS leader and RLDatix Medical Director Dr. Darren Kilroy and Dr. Tim McDonald, RLDatix Chief Patient Safety & Risk Officer and one of the architects of the CANDOR toolkit — and asked them to share their insights on how to advance a culture of safety with patients at the forefront.

Why is patient and family engagement critical to fostering a culture of safety?

Kilroy: We learn best when we humanize harm. In fact, it’s something we’re working on currently with NHS England through a radical national policy change called Learn from Patient Safety Events (LFPSE). I’ve seen the sad consequences of poor — or worse, absent — patient and family engagement far too often. The key to an effective safety culture is putting yourself in the shoes of patients and practitioners impacted by adverse events. Whenever we engage real people in the care improvement process, the event goes beyond basic data and compels stakeholders to do things differently next time — particularly because next time, the person involved could be you or someone you care about.

McDonald: I agree — the patient and their families are the only ones who are present throughout the entirety of the care process. If we are to learn from harm events, we must engage patients and families through review and analysis to ensure we provide optimal resolution. Then, we should involve them in the process improvements and action plan creation to help us all make sense of proposed changes and ensure they align with the needs of those who will be affected by them.

What does “elevating the patient voice” entail and what is required to do so effectively?

Kilroy: Elevating the patient's voice means ensuring that patients have representation in key areas of their care and have agency throughout. In practical terms, this must include dedicated patient representation on the key provider committees, an ability to engage hospital boards in their public fora, a nominated and well-resourced patient liaison team to receive and manage patient concerns and queries and strong channels of communication. On a personal level, patient engagement also mandates clinical teams to involve patients and families in key care decisions and provide evidence for assurance.

McDonald: As the saying goes, “No decision about me, without me.” It’s a simple first step that effectively elevates patient voice while offering the potential to resolve a host of bigger problems down the line. The greatest successes I have seen in this realm are related to the widespread adoption of patient and family advisory councils (PFACs) that focus on quality and safety. We are seeing more data indicating that health systems that utilize these PFACs are on a steeper trajectory toward achieving zero preventable harm. In fact, this is the best example I’ve seen for elevating patient and family voices, especially when they are given a seat on the Board and/or at the C-suite level.

Given the diversity of patient and family identities, how can healthcare organizations best engage them during the course of their care and meet patients where they are?

McDonald: Healthcare systems need to understand the current magnitude of disparities in experience and outcomes. They can only begin to understand that if they are focused on obtaining the proper, self-identified demographic data related to race, ethnicity, language preference and other social determinants of health. From there, organizations need to analyze their harm events, complaints grievances and all other measures of care quality to identify these possible disparities that might be related to implicit bias. This also includes looking at the demographics and histories of our care teams to ensure they are equipped to deliver optimal care to our patients. Objective data is key.

Kilroy: It’s vital that we take every opportunity to reach out to marginalized patients and families to ensure that they are better connected to their care. Solutions range from proactive recruiting to ensuring representation across Board and C-Suite appointments to connecting with professional and charitable partners working to address inequality. Organizations — including our own — need to look within and ask themselves, “Am I effectively representing the diversity of my larger community?” If the honest answer to that is “no,” then we can change things by meeting patients where they are and taking the time to place ourselves in their shoes. Sometimes, it’s not easy, but it’s back to the humanization of care, recognizing diversity and intersectionality, recognizing our shortcomings and moving forward with humility and determination.

We often look at the clinical side of patient safety, but we know that harm can also be administrative in nature. What other touchpoints should healthcare organizations focus on to maximize patient engagement and advocacy?

Kilroy: Some of the most prevalent causes of patient complaints in my years in the C-Suite were around lines of communication or errors and confusion related to administrative tasks. Simple issues of process may not seem clinical when taken at face value, but all of them are laden with risk. Organizations need to be committed to properly resourcing their administrative support teams so that patients and families get clear, accurate and courteous service throughout their care. I always advise organizations that are struggling with the scale of their administrative complaints to do two things — first, look at their balance sheets and acknowledge administrative resource cuts. Then, walk through the patient journey from the perspective of a vulnerable person with limited knowledge about hospital or clinical functions. Combine those two tasks, and you will find your root cause. Often, a penny saved in administrative costs leads to a pound spent on addressing the consequences.

McDonald: I agree with Darren and would add that from the administrative perspective, we must do a better job at understanding our communities and the social determinants of health that impact our patients and their families so that we can adapt our approaches. In addition, data analytics can support the process as we begin to use AI and other predictive algorithms to support and intervene in ways that prevent harm and improve outcomes.

How do you envision the best-case future for patient safety and engagement?

Kilroy: I aspire to a world in which we approach healthcare with a multidimensional ethos, seeing ourselves in our primary role while also seeing ourselves as patients, friends and loved ones. This means a world where an inquiring mind is seen as an asset, not a threat — a world in which being involved in the development and assurance of organizational safety is seen as the ultimate professional ambition, not a peripheral activity. We need a culture shift. Clinicians need to approach their jobs in the anticipation of errors and be actively and visibly vigilant in identifying those errors. Our systems of assurance should explicitly document and assess that vigilance on an individual basis, holding those who fail to engage freely and willingly in the pursuit of error reduction to account. Our healthcare leaders need to be selected, trained, developed and assessed with clinical safety as the watchword in all that they say and do — with mandatory involvement in quality improvement, peer training and learning. We need massively improved transparency in how organizations execute their responsibilities and stronger, dedicated patient representation. Finally, we need all stakeholders to be aware of the part they play in delivering safer care, knowing that their employer will welcome and embrace their participation within a culture of awareness and progression.

McDonald: To add to everything Darren said, we need to support psychologically safe cultures in healthcare where everyone leads with love, kindness and mutual respect. This will bring joy and meaning back to the workplace, and that will go a long way to ensuring the delivery of safe, high quality and efficient care.

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