Patient Safety at 10 Years

Throughout our specialty—at meetings, in our journals, and in our clinics—patient safety has become not only a buzzword but an important focus for plastic surgeons. The cover of this month’s Aesthetic Surgery Journal bears a banner reminding us that 2011 marks the 10th anniversary of the first dedicated instructional course in patient safety at the American Society for Aesthetic Plastic Surgery’s annual meeting in New York City. While advances have been made in the interim that have given both plastic surgeons and patients comfort in safer, better outcomes, there still is a lot more work required. It is those opportunities for continued improvement that are the focus of this editorial, in which we celebrate how far we have come as a specialty and highlight how far we have yet to go. The advantages of patient safety as a part of overall operational excellence go far beyond the maxim of “do no harm”; continued and increased attention to patient safety will benefit our specialty through improved patient outcomes and economic sustainability in an ever-changing environment. There really is a compelling reason to do more and do better than what is being accomplished currently. I (Dr. Jewell) had the pleasure of training under a very gifted professor of pediatric surgery—Dr. Lucian Leape, who went on to coauthor the landmark books To Err Is Human: Building a Safer Health System (1999) and Crossing the Quality Chasm: A New Health System for the 21st Century (2001). Dr. Leape has often said that, according to statistics, care within hospital venues remains about as safe as jumping from a high cliff with a parachute. The purported 1:1000 risk of a serious adverse healthcare event is high, in stark contrast to the safety and quality statistics in other industries, such as aviation. In 2010, there were no reported passenger deaths due to accidents in commercial aviation—a remarkable achievement. On the other hand, a patient catastrophe involving aesthetic plastic surgery anywhere in the world is newsworthy and immediately picked up by media outlets; such “bad news” significantly erodes the public trust. Despite a variety of approaches designed to make healthcare safer (eg, electronic medical records, surgical time-outs, and targeted institutional initiatives for hand washing), there exists a performance gap between what happens every day and what is possible. Even though these methods are practiced universally, excellence has not been achieved according to a recent New England Journal of Medicine article describing minimal improvement in patient safety within hospitals.1 Impeccable quality and safety are within our grasp in the work that we perform, and achieving this will bring increased safety, economic benefit, and a competitive edge. The rationale to “do better” is not a defensive mechanism to avoid professional liability; rather, it is a call to optimize quality and safety in our work and to differentiate ourselves from lesser-trained nonspecialists. While financial incentives for improved performance have been proposed as part of the Affordable Care Act’s accountable care organizations, the idea that initiatives within healthcare reform will have substantive impact on improving safety simply because of a preoccupation with cost is dubious. Besides, incentive payments may become lost in the “institutional overhead.” Gratuitous incentives, crushing bureaucracy, and reimbursement at a rate below Medicare level will prove to be poor motivators for improving safety measures and outcomes. However, there actually is a relationship among quality, safety, and profit when operational effectiveness is present. Patients can trust that they will achieve the desired outcome with the lowest possible risk of adverse events. Surgeons can trust that they will deliver superior outcomes with the lowest risk of reoperation and with great efficiency. Staff can trust that they are working to provide excellent care without compromise. For all involved, there is the need for leadership—not necessarily more bureaucracy or technology—at all levels. Operational effectiveness can become a powerful competitive factor in the delivery of plastic surgery. Rather than relying on government regulations or incentives, we have other options: There exists a basic science of system engineering and process design/management, the application of which leads to exceptional outcomes and safe care. While it is unfortunate that this system is not part of resident plastic surgery training, it is even more unforPatient Safety at 10 Years