\n\tMary Chris Jaklevic<\/span><\/p>\n

People concerned about the safety of patients often compare health care to aviation. Why, they ask, can\u2019t hospitals learn from medical errors the way airlines learn from plane crashes?<\/p>\n

That\u2019s the rationale behind calls to create a \u201cNational Patient Safety Board,\u201d an independent federal agency that would be loosely modeled after the National Transportation Safety Board<\/a>, which is credited with increasing the safety<\/a> of skies, railways, and highways by investigating why accidents occur and recommending steps to avoid future mishaps.<\/p>\n

But as worker shortages strain the U.S. health care system, heightening concerns about unsafe care, one proposal to create such a board has some patient safety advocates fearing that it wouldn\u2019t provide the transparency and accountability they believe is necessary to drive improvement. One major reason: the power of the hospital industry.<\/p>\n

Two measures are underway to create a safety board: A bill filed<\/a> in the U.S. House in December by Rep. Nanette Diaz Barrag\u00e1n<\/a> (D-Calif.), which is expected to be refiled this session, calls for the creation of a board to help federal agencies monitor safety events, identify conditions under which problems occur, and suggest preventive measures.<\/p>\n

However, the board would need permission from health care organizations to probe safety events and could not identify any health care provider or setting in its reports. That differs from the NTSB, which can subpoena both witnesses and evidence, and publish detailed accident reports<\/a> that list locations and companies.<\/p>\n

A related measure under review by a presidential advisory council<\/a> would create such a board by executive order. Its details have not been made public.<\/p>\n

The push comes as many patients continue to get hurt, according to recent reviews of medical records. The Department of Health and Human Services\u2019 inspector general found that 13% of hospitalized Medicare patients experienced a preventable harm<\/a> during a hospital stay in October 2018. A New England Journal of Medicine study of patients hospitalized in Massachusetts in 2018 showed that 7% had a preventable adverse event<\/a> with 1% suffering a preventable injury that was serious, life-threatening, or fatal.<\/p>\n

Learning about safety concerns at specific facilities remains difficult. While transportation crashes are public spectacles that make news, creating demand for public accountability, medical errors often remain confidential, sometimes even ordered into silence by court settlements. Meaningful and timely information<\/a> for consumers can be challenging to find. However, patient advocates said, unsafe providers should not be shielded from reputational consequences.<\/p>\n

\u201cPeople pay vast amounts of money for health care,\u201d said Helen Haskell, president of South Carolina-based Mothers Against Medical Error, an advocacy group she founded because her 15-year-old son died from septic shock following elective surgery in 2000. \u201cProviders shouldn\u2019t be able to sweep things under the rug.\u201d<\/p>\n

Barrag\u00e1n\u2019s bill follows a 2014 effort<\/a> to create a national patient safety board to investigate incidents and make more providers\u2019 safety records publicly available. It stemmed from the Institute of Medicine\u2019s landmark 1999 report<\/a> that called medical error in hospitals a leading cause of death and recommended a nationwide mandatory reporting system for serious adverse events. That campaign never got enough traction to become a congressional bill.<\/p>\n

Patients and their families would still like to know the rate of harm in every hospital, said Lisa McGiffert, president of the Patient Safety Action Network<\/a>, a group discontented with some aspects of the current bill. \u201cWe are so far away from that now,\u201d she added.<\/p>\n

But Karen Wolk Feinstein, president and CEO of the Jewish Healthcare Foundation<\/a>, a Pittsburgh-based philanthropy that leads more than 70 groups pushing the latest safety board campaign, said during an online forum<\/a> in January that public reporting would compromise data integrity by leading hospitals to scrub records to hide bad events.<\/p>\n

\u201cYou\u2019re going to have to protect data for a while \u2014 de-identify it,\u201d she said, \u201cso that we can do what needs to be done.\u201d<\/p>\n

She said that a patient safety board \u201cwill not happen\u201d without broad support, including from hospitals and medical societies. Those groups have long opposed measures<\/a> to publicly identify facilities where errors occur.<\/p>\n

That industry influence is \u201cthe elephant in the room,\u201d said McGiffert. Hospitals, nursing homes, and medical professionals pour hundreds of millions of dollars into federal political campaigns each election cycle and spent $220 million lobbying Congress last year, according to OpenSecrets, a nonprofit that tracks money in U.S. politics.<\/p>\n

Moreover, health care is the dominant employer in at least 47 states, according to Health Affairs<\/a>, which means that, when legislation is in play, the industry \u201ccan always drum up local people to talk about how it affects them,\u201d McGiffert added.<\/p>\n

Feinstein agreed that legislators always ask about the position of their local health systems. \u201cThat is the first question,\u201d she said during the January forum.<\/p>\n

Although patient safety groups represent the interests of millions of people, they don\u2019t have the same financial firepower on hand as the health care industry does. McGiffert said her own organization\u2019s bank balance is $6,000. Feinstein said her foundation is using its endowment \u2014 created with proceeds from the sale of a tax-exempt hospital \u2014 to fund the patient safety board campaign, among other initiatives. The foundation reported assets of nearly $186 million<\/a> in 2021.<\/p>\n

The American Hospital Association<\/a> declined to comment about the patient safety board proposal because it was still reviewing it, said spokesperson Colin Milligan. He provided a statement from the association\u2019s senior director of quality and patient safety policy, Akin Demehin, saying hospitals are \u201cdeeply committed\u201d to safety and have urged that \u201cpublicly reported measures assess hospitals accurately and fairly while giving patients meaningful information.\u201d<\/p>\n

The safety board campaign initially declared the NTSB as its model<\/a>. However, Feinstein said, it now envisions it as \u201csomething of a hybrid\u201d of the NTSB and the Commercial Aviation Safety Team<\/a>, a lesser-known government-industry partnership that analyzes a massive amount of data to detect emerging risks.<\/p>\n

Christopher Hart, a former NTSB chairperson who serves on the board of the Joint Commission, a health care accrediting body, likened the proposed patient safety board to the voluntary reporting of aviation errors and near misses<\/a>, which are statutorily protected from public disclosure. Protecting such tips about non-public events has \u201cenabled a flood of voluntarily provided information\u201d that is \u201cfoundational to improving airline safety,\u201d Hart said.<\/p>\n

But some consumer advocates argue that in health care, secrecy and voluntarism have fallen short. They point to the 2005 Patient Safety Act<\/a>, which lets health care providers submit data confidentially to research groups called patient safety organizations. As of 2018, about 40% of hospitals reimbursed by Medicare didn\u2019t report to such organizations despite liability and public disclosure protections, and most of the organizations didn\u2019t submit data to national research databases, according to the HHS inspector general<\/a>.<\/p>\n

With safety indicators worsening during the pandemic<\/a>, supporters of a patient safety board argue the current proposal would be a step forward. It could hasten adoption of surveillance technology, launch a national portal for anyone to report events, and coordinate efforts of states, federal agencies, and accrediting bodies.<\/p>\n

Barrag\u00e1n will reintroduce the bill in the current term but declined to give a date, said spokesperson Kevin McGuire. \u201cFrom our understanding, the stakeholders we are working with are discussing the concerns\u201d raised by advocates, McGuire said.<\/p>\n

Sue Sheridan, a co-founder of Patients For Patient Safety US<\/a>, became a patient safety advocate after untreated jaundice left her son brain-damaged and her husband died of cancer that went untreated for months because a pathology result was not properly communicated. She now is a member of a working group for the presidential advisory council and said she expects consumer-friendly tweaks to the proposal, including putting patient representatives on the board itself \u2014 a step she said she would support. And she backs the overall effort, despite saying the plan needs to be somewhat refined.<\/p>\n

\u201cWe will be safer with it than without it,\u201d Sheridan said.<\/p>\n

KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n

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