It is without a doubt that health care providers and administrators are committed to protecting the health and safety of their patients. However, the legal, logistical, and human error can severely undermine this commitment and lead to unintended consequences. It has been said that health care is consistently behind other high-risk industries in ensuring the basic safety of its users (The Institute of Medicine, 2000). One area where improvement is needed is in policy management. Manually storing, maintaining, and locating policies is time-consuming and inefficient. Hospitals must be sure that policies that guide patient care are in compliance with regulatory agencies and are quickly and easily accessible to staff members. This will ensure that employees are following proper procedures and creating a safe environment for patients.
In 2000, the Institute of Medicine (IOM) published a report entitled, “To Err is Human: Building a Safer Health System” (The Institute of Medicine, 2000). The report found that between 44,000 and 98,000 patients die preventable deaths each year in hospitals in the United States, and much more suffer from preventable injuries. Additionally, the report estimated that total national costs from adverse events in hospitals are between $17 billion and $29 billion per year. Medical errors and a lack of patient safety also lower patients’ trust and satisfaction in their providers and the health care system as a whole. One of the IOM report’s primary conclusions was that the majority of medical errors are not the result of the actions of specific individuals, but rather faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them (The Institute of Medicine, 2000).
The IOM report made a series of recommendations designed to reduce the incidence of medical errors. The recommendations are in the areas of knowledge, error identification and reporting, safety systems, and most notably, raising performance standards. Specifically, the report recommends “Raising performance standards and expectations for improvements in safety through the actions of oversight organizations, professional groups, and group purchasers of health care.” (The Institute of Medicine, 2000) In fact, one study argues that since the 2000 IOM report, regulatory solutions have been the most important step in reducing medical errors and ensuring patient safety in hospitals (Wachter, 2004). Despite the recommendations, progress since the 2000 report has been slow (Agency for Healthcare Research and Quality, 2009).
One regulatory agency that has responded is the Joint Commission. In 2002, they established their National Patient Safety Goals (NPSG) program to help accredited organizations address specific areas of concern regarding patient safety (The Joint Commission, 2012). The NPSGs for hospitals guide Patient Identification, Staff Communication, Infection Prevention, and Error Prevention in Surgery, among others. For instance, the guidelines indicate that hospital employees should “Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization; set goals for improving hand cleaning, and; use the goals to improve hand cleaning” (The Joint Commission, 2013). In order to comply with this guideline, it is necessary for the hospital to keep its Hand washing policy up to date and easy for staff members to locate and utilize. Proper hand washing prevents a plethora of infections and illnesses and leads to an overall safer environment for patients.
In order for hospitals to stay compliant with regulatory bodies, and in turn improve patient safety, it is critical to have a robust and well-managed set of policies and procedures. One way to do this is through better use of information technology (IT). The federal government recognizes this, and the U.S. Department of Health and Human Services has awarded millions of dollars in IT grants to hospitals (Wachter, 2004).
It is imperative for hospitals to recognize safety risks and strive to create a safe and secure environment for patients. By taking steps to comply with relevant regulations and to efficiently manage the thousands of policies that guide patient care, a facility can ensure that procedures are followed, errors are avoided, and commitments to patient safety are fulfilled.
Agency for Healthcare Research and Quality. (2009, May). National Healthcare Quality Report 2008. Retrieved May 14, 2013, from http://www.ahrq.gov/qual/qrdr08.htm
The Institute of Medicine. (2000). To Err is Human: Building a Safer Health System. Institute of Medicine, Committee on Quality of Health Care in America. Washington, DC: National Academy of Sciences.
The Joint Commission. (2012, June). Facts about the National Patient Safety Goals. Retrieved May 13, 2013, from
The Joint Commission. (2013). 2013 Hospital Patient Safety Goals. Retrieved May 13, 2013, from
Wachter, R. M. (2004, November). The End Of The Beginning: Patient Safety Five Years After ‘To Err Is Human’. Health Affairs.