Dr. Tejal Gandhi, CEO of the National Patient Safety Foundation

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Mark Masselli: This is Conversations of Health Care. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flin ter

Mark Masselli: Well , Margaret she is calling in a solid start to Health and Human
Services Secretary, Sylvia Burwell announced numbers for the first week of open
enrollment on the federal insurance exchange . Roughly a half million customer
signed up for plans.

Margaret Flinter: Still these numbers show that the newly retooled website
h ealthcare.gov can handle the high traffic from residents in the 37 states across
the country that are using the federal exchange.

Mark Masselli: The HHS has partnered with a number of organizations across
the country to help boost in enrollment. They have partnered with the National
Co mmunity Pharmacy Association . West field shopping centers , and other
diverse groups are -- to assisting in getting the word out.

Margaret Flinter: Well , that’s creative going to the shopping centers , and of
course community health canters across the coun try have been working diligently
again to enroll uninsured patients in insurance plans , including getting then
enrolled in Medicaid .

Mark Masselli: There is another phenomenon, this time around Margaret , a
quick survey of premium pricing around the count ry s hows that prices are being
held, in fact do the increased competition , that’s all news for consumers.

Margaret Flinter: And meanwhile officials are expecting brisk business on
h ealthcare.gov on December 15 th , that’s when consumers have to sign up and
pay their first month’s premium if they want their cover age to begin on January 1.

Mark Masselli: Much is changing in the world of health care Margaret , and one
area of gaining particular attention is patient safety.

Margaret Flinter: Well , that is so mething that our guest today knows quite a bit
about. Dr. Tejal Gandhi is President and CEO of the National Patient Safety
Foundation dedicated to ensuring that patients are free from harm. Dr. Gandhi
shows some terrific ideas on how to reduce the causes of medical mistakes in
the healthcare space.

Mark Masselli: Lori Robertson , The Managing Editor of FactCheck.org stops by.
But no matter what the topic you can hear a ll of our shows by going to
CHC radio .com.

Margaret Flinter: And as always if you have comments , please find us on
Facebook, Twitter , Linkedin and Google Plus. We love hearing from you. We
will get to our interview with Dr. Gandhi in just a moment.

Mark Masselli: But first , here is our producer Maria n n e O’ Hare with this week ’ s
headlines news .

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Maria n n e O’ Hare : I am Maria n n e O’ Hare with the se Health Care headlines .
Business has been brisk during the second round of open enrollment on the
insurance exchanges. Especially , the federal marketplace, healthcare.gov,
which was plugged by problems first time around . The Department of Health and
Human Services announces in the first week of open enrollment alone close to
half a million Americans signed up for coverage with a lit tle or no difficulty. But
plans being purchased on th o se exchanges may not offer the most
comprehensive coverage for the more expensive specialty drugs. Folks
purchasing the lowest price d plans , so called bronze plans will be forced to pay
more out of po cket for their more expensive drugs. Fifty Thousand lives, that’s
the number saved according to the Agency for Research Health and Quality
since the 2010 launch of the partnership for patient’s program. The program was
aimed at reducing medical harm . An d in 3 years there has been unprecedented
drop in adverse events in the health care space , about 1.3 million fewer between
2010 and 2013. That is 17% drop in incidents. The program is also instrumental
in significant savings in critical health care spending about $ 12 billion so far . And
obesity exacts a hefty toll globally about $ 2 trillion in healthcare cost . America is
widening earth is a target of many pilot programs aimed at reducing
consumptions. The FDA has approved a program that’s starting in November,
will require most fast food restaurants chains across the nation , including movie
theaters to list calorie counts of their food items. There are smattering of studies
showing overtime consumer s begin to order with more awareness of calorie
intake that they were likely ordering before. Yes, Virginia that double , double
chocolate trufflelata really is 900 calories. I might want to think about it, Grande
black coffee instead. I am Maria n n e O’ Har e with these healthcare headlines.

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Mark Masselli: We are speaking today with Dr. Tejal Gandhi, President and CEO
of the National Patient Safety Foundation and the NPSF Lucian Leap e Institute ,
which is dedicated to creating a world where patients of those who care for them
are free from harm. Dr. Gandhi is an internist and Associate Professor o f
Medicine at Howard School. She was the executive director of quality and safety
at Brigham at Wome n’s Hospital for 10 years. She was also a chief quality and
safety at Partner’s Health Care in Boston. She earned her Masters in Public
Health as well as her Medical Degree from Harvard. Dr. Gandhi, welcome to
Conversations on Health Care.

Dr. Tejal Gandhi : It’s my pleasure to be here. Thank you.

Mark Masselli: You know, the National Patient Safety Foundation was created in
the late 1990s on fairly simple premise to prevent harm and improve patient
safety . And yet as we have learned from the gro und breaking 1999 IOM report to
error is human. Medical mistakes have let an estimated 90 thousand deaths per
year in this country. Could you give our listeners an overview of just how far we
have come since the release of the IOM report , when patient sa fety was not even
part of the national healthcare discussion?

Dr. Tejal Gandhi: Sure . I think that ’s an accurate description , and that when the
IOM report came out in 1999 most people in the public were not aware really of
medical errors . But also in h ealth profession ,m we didn’t really talk about
medical errors, didn’t really think it was a significant problem So, the IOM report
really did open up an whole new field of patient safety . And since then we have
come a long way. Most or i f not all hospitals for example have patient safety
programs , and patient safety teams , and people really who are dedicated to
trying to prevent medical errors . A ccreditors like the joint commission have
specific requirements around patient safety , and look for tha t , and clinician ’ s
nurses, doctors are being trained on patient safety , certainly at the residency
level. Some of the key areas that we have seen some improvement are for
example reducing infection, which again back in 1999 , lot of infections were felt
to be just part of doing business . And if they weren’t preventable , and we have
learn ed that they are , and there has been progress there. And also and really
creating a culture where it’s the expectation that people will talk about mistakes
in order to lea rn from them , which is as pretty significant cultural shift . And we
are now trying to make sure that we are creating that kind of culture across
healthcare .

Margaret Flinter: Well Dr. Gandhi, since the finding of the National Patient Safety
Foundation , this organization stakeholders has elevated patient safety to the
status of a science. But tell us more , who are the partners and stakeholders
working with you in this sheer goal of advancing patient safety ? And what have
you learnt from some of these p artners ?

Dr. Tejal Gandhi: Well in NPSF has always prided itself on really being the big
tent , where everyone can come to the table and work on patient safety together .
And we’ve really realized that there is no way , we are going to drive forward
improv ements in patient’s safety without having everyone at the table. The
p atient first and foremost , healthcare organization, clinician, regulators and
government , and also people from industry , and so having all of those people at
the table is really critica l to advancing the mo vement. Some key lessons learned
as you asked about is first is that culture of safety . We will not make progress on
safety if people are afraid to talk about errors . And so , leading systems have
really created cultures where it is the expectation of everyone in the organization

to learn from errors to improve based on things that have happened to include
the patients in those learning discussions , and make sure that changes a re made
that are not just , oh, we’ll just educated the nurse to not do that again , but really
systematic changes . That hopefully will prevent that error going forward . And I
think that’s the second real lesson learned is that we need to have robust
syste ms to learn from errors. There is no point in reporting an error , if an
organization isn’t set up to really learn and improve based on that error . And we
have started to take learning from other industries like aviation , and nuclear
power , and again t o d esign system s with ways to prevent error , as opposed to
just asking clinicians to work harder and be more careful , which we know will
never get us to the higher liability healthcare systems that we want. And then
last lesson learn ed is the fact that we ha ve to be real focus ed on patient
engagement , and having partnerships with patients to create safer care . The
Lucian Leap e Institute that is the NPSF think tank, put out a report on this just in
the last year about how clinical it is to partner with patien ts to improve care , and
that’s at multiple levels. It’s not only at the sharp end where patients are
receiving care, that, that’s clearly critical , and but that looks like a shared
decision making , really making sure patient s understand what their options are
and that the plan is being created with the patient as a complete partner . But
also having patients sit on hospital committees , and quality improvement
activities and patients on board s of hospitals , and health systems , and so on to
make sure that patient’s voice is really heard throughout the organization.

Mark Masselli: You know, I was thinking as you were talking about one of our
guest who was on Dr. Pronovost[PH] , he was telling us a story about , you were
talking ab out change of culture, about talking in the cardiology group , and how
everybody in the team has to be able , the sort of the Toyota experience, I got to
be able to stop the assembly line going , and just sort of the pr o position that the
nurse could tell one of the leading cardiologist in the world that they are making
mistake s with.

Margaret Flinter: Go back and wash your hands.

Mark Masselli: Go back and wash your hands , was going to be a culture change .
So, really it took to heart some of the thoughts that you just shared with us . But
lets drill down a little on the impact on patient safety , and particularly around
Hospital Acquired Infections . The Centre for Disease Control and Prevention
recently released a report featuring stats on the reduction o f hospital infections .
And the National a nd State Health Care Associated of Infection Progress Report
is complied with data submitted by more than 12 , 000 acute care hospitals across
the nation addressing infection rates . And there has been some really go od
news there, at least in a certain kind of Hospital Acquired Infections . Could you
tell us more about those results?

Dr. Tejal Gandhi: Well , we have definitely made progress according to recent
CDC estimates on infections such as bloodstream infection , and , you know , there

is other types of infections in hospitals as well that the CDC tracks , such as
catheter associated urinary tract infections , and ventilator associated
pneumonias and so on. In the past, it was felt that these were not preventable
ty pes of infections , and just , you know , being in the hospital, these infections
happen . And so , that shift in mindset that these are preventable has been huge .
As well as , really creating better best practices to say , well , how do we prevent
them and tha t , you know , you mentioned and Dr. Pronovost , and his work around
central line infection has been really critical to showing the way for how hospitals
and particularly in terms of care units can reduce rates of these kinds of
infections. I think the other reason s for why we have made progress on
infections ? One the CDC is actually measuring them. We have had a real
struggle in patient safety to measure errors , but in infections we can measure
infections . And so , just having that measurement present is a driver for
improvement . And then other key drivers have been the fact that a c creditor s
such as the joint commission look for a certain activities related to infection
prevention . And also there is financial pena lties tied to having high infection
rates through Medicare . And so , I think this confluence of factors is certainly the
reason for why we have made progress on infections.

Margaret Flinter: Well , Dr. Gandhi, the area of infection control is certainly on e
where we have seen such great progress . Another area that we have seen
some dramatic improvements is in the whole area of medication safety, reduction
and prescribing errors , and the whole area of adverse drug events . And it occurs
to me when we think about the patients safety movement , if we think of 1999 as
kind of a ground zero year . The movement really also coincides with the
development and the implementation , and finally the widespread use of
electronic health records , and electronic prescribing systems . And yet we still
have too many adverse drug events. What’s been the most successful based on
your research in reducing adverse drug events beyond you prescribing ? What
kinds of new system supports have improved our ability to prescribe medicine
and get the best effectiveness with the highest safety?

Dr. Tejal Gandhi: Well , it's a great question. I think your point about the
confluence of electronic health records with the ILM report ed is a good one . And
that it really has brought potential for how we can improve systems in healthcare
by having things more electronic with a better technology etcetera . And
computerized physician or entry , which is basically electronic prescribing in
hospitals , and electronic prescribing systems in the outpati ent setting have made
substantial reductions in those prescribing errors. You also mentioned drug
interactions , and the electronic systems have the potential to prevent errors , but
they have to be used in an optimal way . And so , we still may not be getti ng the
full benefit of even those kinds of systems , if for example we are learning
clinicians about every drug interaction that exists. There has been a real science
around alert fatigue that has started to emerge, that says we can't alert on every
single thing , we need to prioritize . But, you know , even if we prevent prescribing
errors, there’s lots of other ways that medication errors can happen , and

subsequently leading to preventable adverse drug events . And so , like , the
pharmacy dispensing errors . There could be errors in administration , and that
could be in a hospital with a nurse giving the medication at the bedside . That
could be in the home where the patient is taking the medication. There has been
progress . And pharmac ies for example , the re is much better electronic
dispensing system , even these robots for example to help reduce dispensing
errors . And then at the bedside in hospitals, there has been really good evidence
that barcode systems , so, basically the nurse is being able to match that with
barcode technology at the bedside to make sure it's the right patient, the right
drug, the right dose, the right time . Those systems have really shown significant
reductions in those administration areas.

Mark Masselli: We are speaking today w ith Dr. Tejal Gandhi, President of the
National Patient Safety Foundation , and the NPSF , Lucian Leape Institute , which
are dedicated to transforming healthcare systems to better improve patient’s
safety. Dr. Gandhi is an Internist and Associate Professor of Medicine at
Harvard Medical School. She was the Executive Director of Quality and Safety
at Brigham in Women’s Hospital for 10 years. Dr. Gandhi you have been in the
trenches of patients safety for sometime now , and the Affordable Care Act has
numerou s provisions in place intended to f a ster improve patient safety , and
better health outcomes by incentivizing system transformation . And the
Department of Health and Human Services has launched a billion dollar
campaign called the ‘Partnership For Patients To Work Towards Reducing
Patient Harm’. How are these policy directives and g overnment initiatives
enhancing the work that you are doing at the Foundation?

Dr. Tejal Gandhi: Well they are absolutely enhancing the work we do at the
Foundation by having increased focus for hospitals and health systems on trying
to improve patient safety. The partnership for patients and particularly the
hospital engagement networks that we have set up have created collaborative
networks . Organizations that are working t ogether to share best practices and
improve patient safety in these , you know , networks of hospitals and health
systems have been trying to reduce infections , and reduce readmissions , and so
on. So , they’ve really created a way for organizations to share with each other
and learn from each other , which I think is really how we are going to move
forward in patient safety . As we can't -- I will be working in silos, and we need to
really be transparent in sharing. The other way the partnerships for patients has
worked within NPS F is that we for example put out the white paper last year
about partnering with patients for safe care . And they have helped promote that
across these collaborative organizations by having a webinar , and making sure
their constituen ts are seeing the work of NPS F . So , we hope to continue to
(inaudible 16:26 ) like that to really spread the knowledge that we have at NPS F .

Margaret Flinter: Dr. Gandhi the National Patient Safety Foundation has led the
effort to create a new medical sp ecialty in patient safety by developing a
certification system , which I would be interested in hearing more about. Is this a

board level certification , in addition to ones primary specialty area? Tell us more
about that.

Dr. Tejal Gandhi: So , NPS F has created a certification program for any type of
person in healthcare who is doing work in patient safety. This is not a board level
certification for physicians like , a physician would be a board certified cardiologist
for example; it’s a little bit different. You become a certified professional in
patient safety, CB PPS. Our certification means that you have a certain level of
competency in patient safety , and you ha ve to demonstrate that by initially going
and taking an exam . And it’s really intended for people who have been in the
trenches doing patient safety works for several years. You really need to have
practical experience. We are trying to demonstrate that be in the field of patient
safety, there are certain core competencies that people need to have, basically
trying to elevate patient safety as a field. You know I am thinking about when I
used to run a Quality and Safety Program at Brigham and Women’s . W e used to
be trying to hire people to work at our Quality and Safety Department . And so, if
somebody had this kind of credentials, it just demonstrates again that this person
really has a high level of competency compared to somebody who d oes not have
th e credential. So , the certification are a relatively early program . and I would
expect that this would be the kind of credential that every organization around the
country should have someone with this kind of credential in their safety
department.

Mark Masselli: You know , Dr. Gandhi tell us a little more about the National
Patient Safety Foundation , and the Lucian Leape Institute . Wh o were some of
your strategic partners , and what’s next on your agenda in terms of objectives
you have.

Dr. Tejal Gandhi : We have -- really had a national reach since 1997 , and we are
the first organization to have a sole focus on patient safety. We partner with
everyone from acc reditors , and g overnment agencies to industry , and vendors to
healthcare systems. We have hos pital , we have individual members of NPSF
that are folks working in the trenches on patient safety. The NPSF Lucian Leape
Institute is kind of our North star that tells us what activities we need to focus on .
And so , the five areas that the NPSF Lucian Leape Institute has been focusing
on are transforming medical education to include more quality and work, care
integration . Workers safety we call it joy , and meaning at work , which is an
interesting area , we focus so much on patient safety , which we really obviously
need to do . But if the people working in healthcare are not safe or are having
physical , and psychological harm themselves, it will be very hard for them to
deliver safe care to patients. So , we have deci ded that workers safety is really a
precondition to patient safety . And the fourth area is patient engagement . And
the last is transparency . And again , we need to make sure that we are sharing
best practices more broadly to make sure that everyone is le arning and
improving.

Margaret Flinter: We have been speaking today with Dr. Tejal Gandhi , President
of the National Patient Safety Foundation and the Lucian Leape Institute, which
is dedicated to creating a world where patients and those who care for th em are
free from harm. You can learn more about h er work by going to www.npsf.org .
Dr. Gandhi , thank you very much for join ing us on Conversations on Health Care
today.
Dr. Tejal Gandhi : Thanks so much for having me.
(Music) Mark Masselli: At Conversations on Health Care, we want our audience to be truly be know when it comes to the facts about health care reform and policy.
Lori Robertson is an award winning journalist and managing editor of FactCheck.org, a nonp artisan, nonprofit consumer advocate for voters that aim to
reduce the level of deception in US politics. Lori, what have you got for us this week? Lori Robertson: Well, the urban institut e is out with a new report that looks at
healthy Affordable Care Act ha s affected the number of uninsured. A survey
data showed that the number uninsured adults dropped by 8 million between September and June. The open enrollment period for the ACA market places began on October 1 st . The percentage of uninsured in th e United States was an
estimated 13.9% in June compared with 17.9% in September , the survey found.
The drop in the percentage of uninsured was more pronounced in states that expanded Medicaid under the ACA. In those states the rate of uninsured was 10.1% in June; a 6% point drop from September. Meanwhile the states that
haven’t expanded Medicaid there are currently 24 of them have an uninsured
rate of 18.3% , down slightly from a 20% rate in September. These are of course
only estimates from a survey tak en a few months after the first open enrollment
period under the healthcare law s . The data don’t include a breakdown of the
sources of insurance for the previously uninsured. They do however show that
the insurance gains overwhelmingly occurred in famili es whose incomes were
below 400% of the f ederal poverty level. That’s $ 95 , 400 .00 for a family of 4 this
year, making those families eligible for subsidies on the insurance marketplaces for Medicaid coverage. The survey which has been taken quarterly since 2013 is
funded by Robertwood Johnson Foundation, the Ford Foundation, and the Urban Institute. And that’s my FactCheck for this week . I am Lori Robertson, Managing
Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country’s major political players , and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you would like
checked, E - mail us at chcradio.com , we ’ll have FactCheck.org’s Lori Robertson
check it out for you here on Conversations on Health Care.

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Margaret Flinter: Each week Conversations highlights a bright idea about how to
make wellness a part of our communities and everyday lives. In the emergency
room or ICU clinicians are confronted with a myriad of unpredictable medical
crisis that sometimes can be challenging to diagnose. Most of these clinicians
are now communicating with colleagues via their smart phones , often sending
images of a patient’s unique symptoms or chest x - rays to one another for sure
diagnoses. ICU physician Dr. Joshua Landy was noticing a growing trend of
image showing via smart phones to crowd source se cond opinions from friends ,
and colleagues across the country. But he also was concerned about the
potential violation of HIPPA regulations. So , he developed an App for that. He
created figure 1 a sort of Instagram for doctors in which images can be de
identified , but shared across a dedicated social media platform that would allow
input from clinicians within th eir network. Doctors are using th e App to
communicate not only with colleagues within their hospital settings , but around
the world where someo ne might have superior expertise with a certain condition.
The App was recently used to share a chest image one of the patients who
presented with mid - eastern virus, MERS . Dr. Landy says the Apps get about half
a million image views a day with about 80 m illion total views so far. He sees the
potential for this platform only growing as more young digital data enters the
medical workforce. Figure 1 is a free download through Apple App stores and
Google play. A free downlo a dable App offering secure HIPPA compliant image
sharing among clinicians around the world tapping the collective expert instantly.
Now that is a bright idea.

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Margaret Flinter: This is Conversations on Health Care, I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli . Peace and health.

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Narrator: Conversations on Health Care, broadcast from the campus of WESU
at Wesleyan University, streaming live at www.wesufm.org and brought to you by
the Community Health Cente r .

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