📰 Curated Industry Article
This is a summary of a full article from a trusted healthcare and insurance publication. Click “Read Full Article” below to read the complete story.
Never events — the most severe, preventable harms in patient safety — are often seen as some of healthcare’s worst-case scenarios. But they also carry an overlooked distinction: They can only happen to patients who made it far enough into the system to receive care in the first place.
Access issues often are viewed as operational challenges but treating them instead as patient safety events sets health systems up for real progress. That’s the argument Victor Hassid, MD, associate vice president of access strategic operations at Houston-based The University of Texas MD Anderson Cancer Center, makes in an April 7 JAMA article.
While health systems have built extensive infrastructure to track and learn from patient safety events, access failures have largely escaped the same scrutiny. The result, he argues, is a blind spot at the very first link in the care chain, one that can delay or derail a patient’s treatment long before a clinician ever has the chance to make a mistake.
Dr. Hassid recently spoke with Becker’s about what prompted that realization, how UT MD Anderson rebuilt its access operations around a patient safety framework and what executives should do first if they want to close the gap.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: How did you come to the realization that patient access needs to be treated as the first link in the chain of patient safety, and what was your motivation for writing the JAMA article?
Dr. Victor Hassid: When I assumed my role in 2020, I was receiving a lot of emails [about access failures] from concerned colleagues. Many suboptimal events were happening in the access space that were impacting time to diagnosis or treatment, or requiring the correction of wrong diagnoses that had been established outside our organization. There are so many different pieces of the puzzle functioning at different times — asynchronous processes, disconnected processes, multiple individuals and teams working for the same patient. And I realized that we look into each of those components individually.
For such a complex chain involving so many different systems, processes and teams functioning at different times, for something as important as patient health, how can we not have these kinds of conversations between us? We do have them in healthcare — for patient safety events that fit specific boxes: medication errors, diagnostic errors, procedural errors. That’s how care has become so much safer, because we’ve become a lot more critical in how we assess outcomes and what led to them.
In order to even start thinking about that, your patient needs to enter care, and there is so much more risk at the front door than we tend to accept or recognize. But in order to impact it, we need to be able to study it. In order to study it, we need to look clearly into each component in that chain. Only if we do that — and it takes principle — can we take access from the operational throughput domain into the safety quality domain.
Q: Where should a health system leader begin if they want to close this access blind spot?
VH: My recommendation would be, first of all, to align — have executive leadership understand the impact of this mindset shift, and make sure the organization knows about the change in direction. Call it out: This stops being an operational throughput issue and becomes a safety signal for the organization. Once you call it a safety signal, everybody understands that this is going to lead not to episodic, local fixes, but to system accountability and focus.
Executive leaders need to work very closely with their existing safety and quality teams and have an honest conversation with them: If we agree this is a safety signal, how would you incorporate it into your existing mechanisms? First, we need to define what is a reportable event, who is going to report it and which system are we going to use?
Then, we need to create dedicated meetings or channels where those events will be discussed with administrative, clinical and operational leaders. We’re dealing with authorizations, records, scheduling rules, capacity constraints — there’s an intersection between medical practice and operations. Once you start having those conversations, structured around existing safety and quality standards, you’ll get to standardized action items and establish your KPIs.
We also need to take a step back and see our clinical teams. There are many people vested in the best possible outcome for the entire system, starting with patient wellness and good treatment outcomes for the conditions being treated. Imagine if you have a system that functions the way we currently do nationwide — not studying the access failures we’ve been facing at a system level, and continuing to ask teams to deal with the same issues and obstacles again and again. Imagine how demoralizing that is. You don’t have any feedback loops.
We need to expand the KPIs we’re utilizing, identify the best ones we already have available, and challenge ourselves to figure out if there are others we’re missing. There are many patients — we’re talking about access — who we never even see. They never make it to our institution, and we never learn from them. That feedback about their experience interacting with our institution is lost. That’s a huge blind spot. How do we capture that qualitative feedback? First, quantitatively: How many patients do we lose like that? Then qualitatively: What did they experience engaging with our front door? What made them not come?
Q: What did it take to actually build this into UT MD Anderson’s operations?
VH: There is a tremendous amount of work involved in making this change, and it’s work we’re currently trying to standardize at UT MD Anderson. We’ve made tremendous progress in that direction.
For all those clinical teams reaching out through disconnected emails, I felt we had a responsibility to respond to those calls for action: to acknowledge the event, to say what we’re going to do differently, to monitor that it doesn’t happen again, and to continue challenging ourselves to do better.
I’m a surgeon, so I trained in an environment where morbidity and mortality conferences are a key principle in how we practice surgery. We learn from our mistakes, provide feedback, discuss with colleagues, ask for better practices, and go to the evidence. I learned through that and tried to replicate it in access operations.
To make it more pragmatic, I established a weekly conference where all supervisors, managers and staff leaders from access would meet to discuss results and what was happening with a specific initiative. For us, a very important issue was the ability to offer an appointment on the first phone call. We agreed that a patient who has not received prior care and is just reaching out to UT MD Anderson should be scheduled for an appointment within 18 business hours, and that anyone who doesn’t get that is dealt with and approached as a never event. This shift in our mindset and approach allowed us to increase the percentage of patients who get an appointment scheduled within this timeframe from 48% to 78%.
Q: How did you achieve buy-in among team members to reframe access failures as never events?
VH: The first two months, there was a very high tendency to feel that these conversations were about pointing fingers. As a leader, I focused on the process, and I kept making the point clear to my team: This is not about identifying weak individuals, but about identifying weak processes. Everybody comes to work to do the best they can. Sometimes it’s the tools that are missing, the education that is missing, or the processes we haven’t figured out. Ninety percent of the time, it’s a process issue.
Once the group started realizing the impact of the work, the value being added, the commitment of leadership to support the team with tools and resources, and the fact that they had a clinical leader who had their back, it became a cultural shift.
In engagement surveys within the organization, the access division ended up being one of the top-performing areas in terms of psychological safety and engagement, even compared to UT MD Anderson as a whole, and at the 75th percentile for academic medical centers.
Staff turnover in the division of access was around 30% at the time I took over. I had the privilege of working with an incredible administrative dyad partner, and together we lowered attrition to less than 5% three years afterward.
The post Health systems’ biggest blind spot? The patients they never see appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
💡 What This Means For You
Changes within the healthcare industry — hospital mergers, provider network shifts, new care models — eventually affect patients directly, through access, cost, or coverage options. If this raises questions about your own care or coverage, Armfox Healthcare’s advisors are available for a clear, no-pressure conversation.
ARMFOX HEALTHCARE
Stay Informed. Protect Your Future.
No pressure. No jargon. Just honest answers from advisors who genuinely care about your family’s protection.
📰 This article is sourced from a trusted healthcare and insurance industry publication. Armfox Healthcare shares this for informational purposes only. Always consult a licensed advisor for personalized guidance.