The Role of Philanthropy in Preventing Health Care Harm

The Role of Philanthropy in Preventing Health Care Harm

Preventable harm in health care is a leading cause of death in America and must be tackled more comprehensively — as a public health crisis — than it has been to date. Philanthropy has a key role to play, and it's highlighted in a new developed by the .

The call to action builds on successful efforts to reduce health care-associated infections and is inspired by America's long history of coordinated public health responses to specific diseases and conditions. That history produced what arguably is the greatest advance in America in the twentieth century: an increase in the life expectancy of Americans of some thirty years.

Efforts to improve patient safety have been ongoing for several decades, but the improvement has been limited. What's needed now is a shift from reactive piecemeal interventions driven by individual organizations to a coordinated system-wide effort aimed at providing safe care delivery across all aspects of care. Philanthropy is essential to that shift, and its role should play out across several dimensions.

First, foundations and other funders are needed to help build a consensus around the importance of a coordinated national effort to eliminate preventable harm in health care. As a nation, we know how to create successful public health responses to crises. Preventing harm in health care certainly rises to that level, and because so much of that harm is preventable, failing to combat it comprehensively is nothing less than tragic.

Second, philanthropy can help to establish patient safety as a core value in health care. Patient safety isn't simply an aspiration; it should be a fundamental organizational priority for health care providers. And promoting a culture of safety throughout health care should be paramount. What's the point of health care if patients are not safe?

Third, patient safety deserves greater support as a field of research that identifies causes and interventions that work. Because health care harm is a leading cause of death in America, funding for research on its prevention should be at a level comparable to research on major diseases. In fiscal year 2016, however, a year in which the allocated $5.4 billion for cancer research, NIH provided only $900 million for patient safety. A vital element of research in patient safety should be measuring and monitoring progress. In that regard, philanthropy should focus some of its support on the creation of a common set of objective safety metrics and then ensure its widespread adoption.

Fourth, because the engagement of patients and their families is vital to achieving the safest care, philanthropy can help inform, educate, and empower the broader patient community. Patients should be engaged as part of a culture of safety, in root-cause analyses, and through specific initiatives. The latter include shared decision-making, playing an active role in bedside rounding, removing limits on family visiting hours, and making available patient-activated rapid response teams.

NPSF's call to action is a blueprint. It is designed to engage stakeholders in a more robust discussion of the need for a coordinated public health response to the problem of health care harm and how best to craft it. It focuses on six priorities — each accompanied by a recommended action, a suggested tactic, and a set of key stakeholders.

The six priorities are: define the problem and set national goals; coordinate activities across multiple sectors to ensure widespread adoption and evaluation; inform, educate, and empower the community; effectively measure and monitor progress at all levels; identify causes and interventions that work; and educate and train. For each priority, the stakeholders vary, but in total they include those who set health care policy, deliver care, insure care, receive care, support patients, fund or research innovations, advocate innovations, and create partnerships.

The call to action proposes roles for each of the stakeholders, making it easy to see what the roles are and how they are interrelated. Together the components form a coherent, comprehensive strategy — and, once activated, a coordinated public health response.

By its definition, preventable harm in health care can be avoided. It's time to take action to do so. We can no longer accept something that's preventable as somehow resistant to change.

Tejal K. Gandhi, MD, MPH, CPPS, is president and CEO of the . The call to action on which this commentary is based is available at .


July 27, 2018