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Physician executive Timothy McDonald discusses his article, “How innovative partnerships are transforming patient safety in health care,” highlighting the role of collaboration in reducing preventable harm. Timothy explores how data sharing within and across health systems can uncover insights to enhance safety measures, emphasizing the importance of Patient Safety Organizations (PSOs) in identifying patterns of medical errors. He also discusses the impact of public-private partnerships (PPPs) in driving health care innovation, citing successful initiatives like the Center for Medicare & Medicaid Services’ Partnership for Patients. Through strategic collaborations with technology companies, hospitals can leverage cutting-edge solutions to improve patient safety. Listeners will gain actionable insights on how health care leaders can foster partnerships that prioritize safer, more effective patient care.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Timothy McDonald. He is a physician executive, and today’s KevinMD article is “How innovative partnerships are transforming patient safety in health care.” Timothy, welcome to the show.
Timothy McDonald: Oh, I’m so glad to be here, Kevin. I love the work you do pushing out all these important messages to health care.
Kevin Pho: Well, thank you so much for coming on. Just briefly share a little bit about your story and journey before we talk about your article.
Timothy McDonald: Sure. So, I am, as you mentioned, a physician executive. I actually did residencies in pediatrics and anesthesiology and a fellowship in peds anesthesia critical care, all in Boston. I moved to Chicago in 1989 and got heavily involved in legal issues due to my work with children who had been abused. So I decided, Kevin, to go to law school at night while practicing my anesthesia and critical care during the day, and I became a licensed attorney in 1997. I’ve been that ever since.
I’ve worked at the interface of medicine and law for the last 27 years, and that’s how I got heavily involved in patient safety issues when the IOM report came out and then encountered a lot of the professional liability problems we ran into in the early 2000s. So that’s been my focus: patient safety. And a lot of it—even alluding and going into the article—is the need to create partnerships between our health care organizations and providers and so many other groups: like patients and families, like professional liability carriers, and even technology companies that really can help us with the data, so that we can begin to get safer because we know we still have huge problems in patient safety in this country.
Kevin Pho: All right, your KevinMD article is titled “How innovative partnerships are transforming patient safety in health care.” Talk about the events that led you to write this article in the first place.
Timothy McDonald: Well, so, I can tell you that many years ago, when I was an executive working in Chicago, we had a patient who ended up having a missed critical test result, Kevin. Our organization missed it. She got discharged from our hospital, and she ended up dying six weeks later. The test result we missed was a very abnormal white count indicating leukemia. When we learned about it at my hospital and we wanted to reach out to her family, the legal system at the time said, “We don’t do that.” You’ve heard that recommendation over and over: don’t say anything and just hope it goes away.
Unfortunately, the family was medically savvy. We ended up getting sued. We spent hundreds of thousands of dollars defending the indefensible. We learned very little, and we settled for millions of dollars on the courtroom steps. At that point, I realized that first we needed to create partnerships based in transparency and empathy with patients and families. Then, we took it from there into a whole lot of the other work that we can talk about.
Kevin Pho: All right, so talk about these partnerships as you discuss them in your article.
Timothy McDonald: One of the first big ones that we discovered really was partnering with patients and families. In fact, very early on in a lot of the patient safety work—as you may be familiar with, and it’s in the article—CMS had this “Partnership for Patients” that started many years ago. We found, by doing that, we could really reduce the number of harm events in health care. It was hugely powerful and productive, that kind of partnership.
But it goes on further: we know, Kevin, that we can’t fix what we don’t know about. There is a lot of data out there, but it’s not actionable. So another big partnership is: how do we get this data—for example, into patient safety organizations—so we can create learning from one health system to another, much like aviation does? That is a huge partnership that we’re able to do on the data side, often partnering with government entities like CMS on some of these projects.
The other big one I’m really happy to be involved in is the partnership between organizations and their liability carriers. Those carriers can really leverage and support and promote patient safety, because they often are the ones that incentivize it. A group I work with, Beta Healthcare Group in California, is incentivizing nearly 60 of their hospitals to create partnerships between the organizations and patients and families so we can learn from these events.
Finally, there’s the technology side. I work with a technology company, and one of the things we’re able to do is bring all of this disparate data together, turning it into actionable data—especially now with artificial intelligence—so we can give feedback to hospitals to understand ahead of time, and even proactively, how we might prevent all these patient harm events from happening. The data that we share shows that one in four patients suffers an adverse event in a hospital. Of those, one in four is preventable, which means 10 percent of all our patients in hospitals suffer preventable harm. We need these partnerships, and we need to be able to leverage this data.
Kevin Pho: So give us an example or paint a picture of what a partnership with these patients and families would look like.
Timothy McDonald: Well, I can tell you for sure that what we learned very early on—and it’s well published—is that when harm happens in hospitals, the only person there the entire time is the patient or the family member. Too often, when we have these harm events in hospitals, we don’t get their input. When we decide to change the way we’re going to deliver care, we’re not actually talking to the people most affected by that change.
What CMS has put forward with their patient safety structural measure is this idea that we need to partner with them, get their input into what these harm events are, so we can begin to fix it and make it better in the future. An example would be: we had one of these cases where I worked where it was the family that shared with us, Kevin, that some in respiratory therapy coming in the room wore gloves and washed their hands, while others didn’t wash their hands or wear gloves. We never would have known that without talking to patients and families. We were able to make a big change based on that, and it significantly reduced infections. You don’t get that unless you partner with patients and families.
There are also a lot of issues these days, as you know, in diagnostic error. That means we need to partner more with patients and families to get their insights into what’s happening to their body, so we can better make the appropriate diagnosis. Lots of examples show that if we engage patients and families, we can make a difference. There was a study out of Texas that showed, when you interview patients and families after harm events, you find 80 percent more strong process improvements, and you do begin to reduce harm. That’s just one example of working with patients and families and the difference it can make.
Kevin Pho: When you first introduced yourself, you told a story about how, from a legal standpoint, they wanted you to reduce that transparency and not talk about that error. Do you still have that cloud of legal suspicion that interferes with transparency, or have they come to accept that an open partnership around a medical error and being transparent with patients and families has a net benefit?
Timothy McDonald: We’ve now been able to publish a lot of data, Kevin, with all the stakeholders we work with—these partnerships—and we’ve shown that transparency, empathy, and honesty after harm does not increase the likelihood of lawsuits. You actually do get safer, and you drive claims down, which is why one of the partnerships I work with, Beta Healthcare Group in California, incentivizes hospitals to be open and honest with patients. They know that not only will it provide safer care, but you’ll end up having decreased claims. There’s a financial ROI that goes along with this.
Again, we’ve published this; it was a lot of my work that was part of a partnership with the federal government, specifically the Agency for Healthcare Research and Quality. We were able to show this approach helps make care safer, and it decreases claims and lawsuits. With that, we’ve begun to shatter the wall of silence. More and more organizations around the country are learning this message and beginning to look at it from this angle, pulling in all these stakeholders to do this work. It’s also one reason why CMS now recommends that all organizations adopt this transparent approach, which is really cool to see. It’s only been about 15 years, and a lot of us in the field are very happy to see the message getting out there. It’s good for patients and families, and it’s also really good for us providers. You can imagine, as a doc, when we’re involved in a harm event—especially when we’ve made a mistake—we can suffer great emotional angst from it. Part of the work within organizations is making sure we provide peer support for the nurses, the physicians, the pharmacists, and everyone who may be involved in some of these cases. Like the one I mentioned early on in the podcast—the people involved in that case were horribly affected by it.
Kevin Pho: So talk to us about some of that support. Sometimes, when multiple individuals from a health care institution are involved in a harm event, they’re instructed by some malpractice carriers not to talk to one another about the case, and they proverbially suffer in silence. When you talk about support—peer support, support for staff members—what would that look like optimally?
Timothy McDonald: There are often three tiers, Kevin, and I give credit to Sue Scott from Missouri for this. The type of support we teach and train organizations to provide is what we call Tier 2, which is peer support. It’s where you train doctors to support doctors and nurses to support nurses, providing almost immediate peer support for those involved in an event. The power of this was highlighted in an article by Albert Wu in the BMJ, calling it the “second victim.” We don’t use that term anymore—we talk more about the “traumatized caregiver”—but you literally build a program in your organization where you have trained peer supporters so that, when one of these events occurs (often supported by software), a trained peer supporter proactively reaches out to the physician to check in and see how they’re doing.
The data is amazing when you see the impact it has. We had the opportunity to publish an article in the New England Journal about why this was so important, especially during COVID. You reach out to the physician, check in, make sure they know the organization supports them and that you’ll be there for them. If they do experience that kind of organizational support, they have half the burnout of those who don’t receive support, and the units they work in have lower mortality rates. This connects the data, showing that this is hugely important.
Now, back to your point: When we teach and train this, Kevin, we tell peer supporters about the need not to discuss the event itself, but to focus on the emotions and struggles people are having. That way, you can assuage the fears of defense attorneys and others, because you’re not talking about the specific facts of the event. That’s another part of the organization that handles those details. But it’s a great partnership: the organizations with their individual staff members, often supported by software. You have to track whether you’ve been able to get peer support to these people and see it. You also want to track your data to see whether you’ve reduced burnout, because the data shows you will, and to see whether you increase retention by doing that.
Kevin Pho: Give us a sense of how prevalent this transparent approach is in the country when it comes to medical errors and medical harm. Is what you’re describing commonplace? Do we still have a long way to go? Is it the minority of institutions?
Timothy McDonald: For instance, I can tell you in California, a large number of hospitals are doing this, partly because of incentives from their professional liability carrier. I’m working with more than 800 hospitals around the country on this, including some very big health systems. There has been a lot of momentum since we published our data, Kevin, showing the positive ROI from an emotional standpoint and a financial standpoint. It’s beginning to spread around the country, and in fact, there’s been legislation passed in Iowa, Colorado, Minnesota, and Utah that enables this kind of activity. We’re making a lot of progress, and that’s why it’s so great to be on your podcast. A lot of what you do—getting it out to the public—helps create this momentum and encourages these partnerships we’ve been discussing. I’m just so thankful to be able to come on and chat with you about it.
Kevin Pho: So those states you mentioned that are creating legislation to encourage these partnerships—what are some examples of what that looks like? Is it malpractice protections? How are they encouraging it through legislation?
Timothy McDonald: Oh, that’s a great question. I can share Colorado as an example because we do a lot of work there. There’s a physician-attorney there named Jean Martin who runs a lot of the work in Colorado. The legislation basically says that if there’s one of these harm events, you can reach out to the patient or family and have a “candor” conversation—candor stands for “communication and optimal resolution.” If you do that, it happens in a protected space, and you are encouraged to try to resolve it with the family without litigation.
If you’re able to do this, and you’re being proactive by reaching out to the family—they haven’t filed a claim or a lawsuit—there’s no need, Kevin, to report them to the National Practitioner Data Bank, and by that state law, you don’t have to report the docs or the nurses to the state licensing boards. That’s one of the big fears: physicians don’t want to be transparent. This encourages and enables that. It’s why there’s been a huge increase in this partnership and these ongoing conversations.
Another thing they’ve done in Colorado is create a repository of learning from these types of events. Again, it goes back to what you and I talked about earlier—this idea of taking our data and getting it into patient safety organizations so we can learn from it. Colorado is actually doing it based on these types of cases. It’s the technology connection and the human connection with these harm events. The legislation in Minnesota, Utah, and Iowa is very similar to Colorado, incentivizing us to do the right thing and not punishing people for reaching out, being open and honest, and learning from these cases.
Kevin Pho: Now, you alluded to this earlier in terms of the impact on patients. Go into a little more detail: how do patients typically respond to this transparency?
Timothy McDonald: In general—and this is a vital part of it—there is a great deal of relief from patients and families when they learn what happened to their loved one. In fact, there’s a lot of data showing that if you don’t have these conversations, as life goes on and they know these harm events happened but didn’t get transparency, they become less trusting in the health care system. When you’re open and transparent, a recent article shows they are much more likely to trust the health care system, and they can be very forgiving when they learn what actually happened if, and this is key, you are committed to making sure it doesn’t happen again.
In fact, one of the things we recommend is, if you’ve had a tragic harm event, you offer patients and families the opportunity to be part of the improvement. That’s another partnership—collecting that data, putting it into your software, and tracking the positive impact it has. So that’s what we generally hear from patients and families: they want to know what happened, and they want to know what you’re doing to ensure it doesn’t happen again. Appropriately, sometimes it’s necessary to provide financial resolution for them when it’s been a serious harm event with a lot of damages.
Kevin Pho: We’re talking to Timothy McDonald. He’s a physician executive, and today’s KevinMD article is “How innovative partnerships are transforming patient safety in health care.” Timothy, let’s end with some take-home messages that you would like to leave with the KevinMD audience.
Timothy McDonald: Well, I think the primary thing is that if we are going to improve health care—meaning we still have patient safety problems—we need a paradigm shift. We need transparency, honesty, empathy, and learning from these events. That’s where, now that we’re seeing huge improvements in AI and in capturing data, we need to take the data using AI to understand how we can prevent these harm events before they happen and track whether the improvements we’re making actually make a difference.
I really am trying to encourage that partnership between all health care providers and organizations and patients and families, because together I think we truly can become safer. But it’s going to require this shift in our paradigm and the way we do things.
Kevin Pho: Timothy, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.
Timothy McDonald: Thank you, Kevin. It’s been an honor and a privilege to chat with you.
