Dr. Karen Wolk Feinstein
President and CEO, Jewish Healthcare Foundation
Dr. Karen Wolk Feinstein, president and CEO of the Jewish Healthcare Foundation, is one of the nation’s leading voices in patient safety and healthcare quality, and she’s ready for a fundamental change in how we identify, analyze, and address incidents of medical error.
I am not one who believes that if you do a larger dose of something that doesn’t work, you’ll get cured,” Feinstein said. “So I knew that we were likely to have a new administration who would be looking at the other aspects of the Affordable Care Act, which have to do with quality, safety and workforce, that we might have an opportunity to do something big, not what we’ve been doing in the past, because it hasn’t worked.”
Feinstein has called for a National Patient Safety Authority (NPSA) to address what she sees as inefficient and impractical standards when it comes to medical safety in the United States. At the moment, best practice standards call for practitioners to “go into a mode of root cause analysis” immediately in response to every incident, whether major or minor, which, Feinstein pointed out, is impractical for the frontline of healthcare “where there’s a certain amount of frenzy that makes it very difficult to be able to stop what they’re doing.”
By some estimations, medical error is the third leading cause of death in the United States, with very little progress in the past few decades. So, Feinstein is advocating for a big change in approach, starting by looking at how other industries stay safe. “They almost all have a national authority committed to their safety,” Feinstein found.
Her vision for a national medical safety authority would follow the model set by the National Transit Safety Board (NTSB). “It does a lot of research and comes up with solutions, but it doesn’t regulate sanction, and penalize. And we found that that would probably make it much more popular and bring about less resistance.”The organization would use a centralized repository of credible data to analyze incidents of medical error, and set criteria for prioritizing the incidents to investigate first. “That would be a central data repository evaluating the others who were already collecting data, only relying on the best, forming partnerships, and most importantly, promoting the ongoing surveillance, detection, and monitoring of adverse events and bringing about autonomous correcting action,” Feinstein said.
But she acknowledges that bringing about such a change won’t be easy, especially in times of turmoil such as these, even as the pandemic has brought to light large gaps in our system. “In so many ways, the pandemic is consuming resources of every kind, intellectual, clinical, financial,” Feinstein said. “But it has also exposed so many flaws in our system. Our logistics, our distribution systems are terrible. Our public health infrastructure is sorely lacking. So we see a lot of things that we think people will say, look, when we get this settled down, we need to rebuild.”