The current state of patient safety – a reflection
Rising patient caseloads, financial stress on healthcare organizations and clinician burnout put extreme pressure on patient safety.
Sometimes, great tragedies conceal other trends that merit our attention. That’s been especially true with the COVID-19 pandemic. Millions worldwide have died, and in the U.S., the number of COVID-related deaths (as of Nov. 2, 2022) has reached 1,065,276, according to the National Center for Health Statistics.
Meanwhile, the impact of the pandemic on the well-being of non-COVID patients has been substantial and needs to be understood. From April 2020 through the end of 2021, Americans died from non-COVID causes at an average annual rate of 97,000 more than should have been expected.
In addition, the National Bureau of Economic Research calculated that there were 32,000 more deaths than normally occurred from hypertension and heart disease, while drug deaths, diabetes, homicide and motor vehicle fatalities during the pandemic all exceeded norms. Casey B. Mulligan and Robert D. Arnott, who collected this data, say this amounts “to a historic, yet largely unacknowledged, health emergency.”
This alarming rise in “collateral” damage from the pandemic does not mean the quality of healthcare skills in the U.S. is in decline. But the number of physicians and nurses with the necessary skills is in decline; there has been a frightening increase in burnout among caregivers.
Difficult C-suite choices
Hospital administrators, already struggling before the COVID pandemic – contending with mergers and acquisitions, closures and layoffs, all while facing higher costs in everything from technology to bandages – now were forced to make agonizing decisions.
With such a surge of unanticipated patients arriving because of the pandemic, hospitals canceled or postponed elective procedures for millions of people, primarily to keep capacity available for COVID-19 patients and to avoid infections. A WHO/Europe study reports that each delay almost certainly led to worse health, prolonged recovery and decreased chances of survival among those who sought treatment for non-COVID conditions.
Rising clinician burnout
The classic definition of burnout cited by Christina Maslach, Ph.D., in an article for the American Psychological Association is a “syndrome involving emotional exhaustion, depersonalization and a diminished sense of personal accomplishment.” What would that look like in a healthcare caregiver? Especially one of those responders involved in COVID care?
Based on their responses to several research studies, healthcare workers are stressed out and stretched too thin. Almost all say they are experiencing stress – some 86 percent are anxious, 77 percent feel frustrated, 76 percent exhausted and 75 percent overwhelmed.
No matter what terms are applied or what distinctions are made, it is clear caregivers are burned out. This condition puts them at great risk and has had a negative impact on patient safety.
The Centers for Disease Control and Prevention reported on Dec. 3, 2021, that more than 26,000 healthcare providers who worked directly on COVID-19 response activities, exhibited depression, anxiety, PTSD and suicidal ideation.
For example, the pandemic made it difficult for front-line personnel to take time off – they were nearly twice as likely as others to experience symptoms of an adverse mental health condition. The most common reasons for their depression were concern about falling behind at work and feeling guilt. When such circumstances and feelings are clustered within a single institution, there is increased absenteeism, higher turnover, lower productivity and lower morale. Compared to pre-COVID reports about depression and anxiety among public health workers, there was an alarming spike in the prevalence of PTSD. These individuals believed themselves inadequately compensated, unappreciated, and they feel they are disconnected from family and friends.
Staffing shortages
Health worker burnout threatens the nation’s public health infrastructure. It has been estimated that half a million registered nurses retired by 2022. The U.S. Bureau of Labor Statistics projects the need for 1.1 million new registered nurses across the nation. Further, within the next five years, the country faces a national shortage of more than 3 million low-wage health workers.
Meanwhile, The Association of American Medical Colleges (AAMC) projects that physician demand will continue to grow faster than supply, leading to a shortage of as many as 139,000 physicians by 2033, with the most alarming gaps occurring in primary care.
Even among doctors and nurses who want to stay in healthcare, about a third are considering switching employers, according to Bain and Company. Its research shows that roughly half of clinicians surveyed report their mental health in decline since the start of the pandemic.
Of those considering leaving the field entirely, 89 percent cite burnout as the main cause. Also, 40 percent of all clinicians surveyed say they don’t have the resources they need to operate at full potential. They report a lack of effective processes and workflows, supplies and equipment. And 59 percent don’t believe their teams are adequately staffed.
Such challenges, including turnover and potential departure from the industry, come as the healthcare industry is already facing a tight labor market that is on track to be short 38,000 to 124,000 physicians by 2034, according to data from the Association of American Medical Colleges.
The impact on patient safety
These shortages are bound to affect patient care. For example, normally, an ICU nurse manages two patients over the course of a shift. When there are shortages, the same nurse will need to take care of three or four patients. This is less than ideal, especially when similar staff stretching occurs in emergency departments and medical admission wards, where it results in significant delays in care, difficulty in securing hospital beds and poorer healthcare outcomes.
This becomes a vicious circle. When medical mishaps occur, the patients are the direct victims but the emotional and physical toll of imperfect treatment produces relentless stress and frustration among the professional care givers themselves.
When the pressure becomes too great, the risk of burnout grows, the number of staff vacancies increases, and the remaining permanent staff are forced to do more with less support. And within this tightening pressure, even more burnout occurs, leading to unfavorable outcomes, patient dissatisfaction, and increased complaints from patients and their families. Health professionals who are emotionally fatigued often seem cold and distant and that too compromises the quality of care.
What Next?
The COVID-19 pandemic accelerated the already enormous financial and care delivery challenges that the healthcare industry faces. Staff shortages, burnout and the ongoing care backlog are stretching the resources of healthcare organizations, putting them in a bind where they must manage costs while improving operational processes.
More health workers are needed – but can enough be found? Can the circumstances in the workplace be changed so that the incidence of burnout is sharply reduced? Can the burnout that afflicts health workers be managed while, at the same time, enhancing the quality of care that patients need? Can experts come up with approaches that will identify distressed caregivers sooner and mitigate the human toll that has been taken by burnout and shortages?
Here is a concise and accurate assessment of the situation:
"Patient safety is reliant on the psychological safety of our caregivers," said Aimee Samuels, Patient Safety Officer, Samaritan Health Services. "Without a comprehensive and systematic approach to peer support after medical harm, our employees are left to suffer alone in shame and fear. A visible and accessible platform to proactively connect peers – without barriers – affirms our commitment to the psychological well-being of our caregivers and creates an environment where we are safer together."