Q&A: The Joint Commission's Dr. Haytham Kaafarani on safety priorities, care disparities and more


Haytham Kaafarani, M.D., M.P.H.

In September, Haytham Kaafarani, M.D., M.P.H., became Chief Patient Safety Officer at The Joint Commission. Dr. Kaafarani is an associate professor of surgery at Harvard Medical School, with more than 10 years of experience as a surgeon and intensivist at Massachusetts General Hospital. At MGH he also served as Director of the Center for Outcomes & Patient Safety in Surgery, Director of the Wound Center, and Director of Trauma & Emergency Surgery Research. Dr. Kaafarani received his master of public health degree from Harvard University and his doctorate from the American University of Beirut, Lebanon.

Patient Safety Beat: As Chief Patient Safety Officer at The Joint Commission, what safety risks do you consider to be of highest priority?

Dr. Kaafarani: I have dedicated my life to improving the safety and quality of care for patients by the bedside, in wards, clinics, emergency rooms, and operating rooms. At the hospital level, I have seen firsthand how safe and reliable systems are often the difference between life and death for our loved ones, even when all clinicians are trying their best. High-visibility and sentinel events like wrong-site surgery, retained foreign bodies and medication errors will always be top priorities at The Joint Commission. We need to prevent that harm as we strive to one day achieve zero harm. Safety risks related to infection and the environment of care, whether in the hospital’s ventilation system or sterilization process, will always be at the core of how we strive for safety at The Joint Commission.

In addition, I would like us to move closer to improving safety in everyday, less visible care events. I think we can do this by asking questions in four different domains of care: Appropriateness — Did the patient receive a medication they needed or a procedure they needed in the first place? Access is at the core of appropriateness.

Second, effectiveness — Did that medication or procedure deliver the intended health benefit?

Next, safety — Was the way the medication was given or procedure performed safe?

And, of course, quality – Was care performed in the best manner possible to be safe and effective?

Safety, in my opinion, encompasses all of these domains. If the outcome is not optimal, we must ask ourselves, “Where did we go wrong? Why aren’t we providing the most appropriate, most effective, safest and highest quality care to every patient, every time?”

Patient Safety Beat: The pandemic posed a new challenge to ongoing patient safety efforts. How is this experience of nearly three years affecting how organizations approach safety today?

Dr. Kaafarani: To be honest, as an acute-care trauma surgeon and intensivist, this question is very personal for me. At the start of the pandemic, as a trauma surgeon and intensivist, I jumped fully into caring for the sickest COVID-19 patients. It has been a rough couple of years, witnessing the pandemic's impact on care.

I see three ways in which the pandemic dramatically affected patient safety:

First, rates of morbidity and mortality were very high, specifically among COVID patients. We have lost too many loved ones to the pandemic, especially during the early waves.

Second is the delay and worsening of care of non-COVID patients, which is often underappreciated. Surgeries were canceled because of infection risks and capacity issues. Patients with chest pain avoided hospitals, mental health patients could not access the care they needed. At the same time, disparities of care worsened, affecting underserved populations the most. All this delay and poor access to care is a pandemic of patient safety within the pandemic itself.

Raising awareness among clinicians and patients is one way to begin tackling this issue. Another is to systematically measure disparities in every aspect of care we provide. We measure results in many areas of health care; every time we do, we must check for disparities, otherwise we will not make progress.

The third way that the pandemic affected patient safety is through workforce burnout. This is a very serious problem, with repercussions we will see for years to come. Burnout contributes to capacity and access issues. We must take care of the nurses, physicians, pharmacists, and all the bedside clinicians who stepped up to the challenge during the pandemic, at the expense of their own families and their own mental health. Combatting workforce burnout will require serious effort on the part of health care organizations. We simply cannot yoga our way out of this.

Patient Safety Beat: The two most recent Sentinel Event Alerts from The Joint Commission focus on disparities in safety and quality based on a wide range of biases — race, ethnicity, socioeconomic status, age, gender and more. This is a complex topic, but are there actions organizations can take now to address those biases?

Dr. Kaafarani: Eliminating disparities is at the top of The Joint Commission’s priorities. Our President and Chief Executive Officer, Dr. Jonathan Perlin, who joined The Joint Commission earlier this year, has singled out improving equity, diversity and inclusion as a top strategic goal moving forward — within the Commission as well as across all Joint Commission-accredited health care organizations. In my mind, any health care disparity is a major safety issue. Whether based in individual implicit bias or systemic issues, health care disparities should be eliminated, plain and simple.

Raising awareness among clinicians and patients is one way to begin tackling this issue. Another is to systematically measure disparities in every aspect of care we provide. We measure results in many areas of health care; every time we do, we must check for disparities, otherwise we will not make progress.

A third way is to standardize care when feasible, without depersonalizing the care we provide. When we standardize by providing care irrespective of the patient's gender, sexual orientation, race, ethnicity, religion or cultural background, we avoid implicit bias and focus on the patient’s needs. When we individualize care based on actual needs, we provide higher-quality care.

Patient Safety Beat: It appears you started working on patient safety early in your career. What sparked your interest?

Dr. Kaafarani: I became interested in safety very early in my surgical training. As a junior resident, I constantly contemplated, “How do I make my patient safer?” and “How do I help them recover?” But still, I made mistakes and witnessed adverse effects. If a patient was harmed, I felt horrible, and sometimes it took me days or weeks to fully recover. As well-intentioned as I and every health care professional around me was, we still witnessed bad outcomes.

I wanted to understand and measure adverse events, especially in intraoperative care. I published extensively about all aspects of what happens inside that “black box,” the operating room. I wanted to learn how to prevent the next error from happening and gradually understood that every system delivers exactly the results it is designed to deliver and that creating safe systems and measuring safety are key to improving it. Today I am still as passionate about safety as I was during those early days.

Patient Safety Beat: You came to the U.S. from Lebanon as a fourth-year medical student. How can organizations best welcome and assist students and others coming here from overseas to work in health care professions?

Dr. Kaafarani: If you had told me as a teenager growing up in civil war-torn Lebanon that I would become a surgeon in the United States and then lead patient safety for The Joint Commission, I would simply have laughed. I had no clue! But I believe this is the beauty of the United States. It is a dream for many across the world that, with enough determination, hard work and passion, one can indeed make a difference.

I would like to see organizations develop cultural competence, seek talent everywhere and be open to different ways of looking at things. Postgraduate training programs in the U.S., for example, are biased against international medical graduates in the residency match process. Unfortunately, they all get lumped into one basket and often get filtered out as a group from selection. I would like to see health care organizations become more open-minded and recognize the talent of individuals regardless of their cultural differences. A diverse team is always a stronger team.


We want to hear from you!

Email us your feedback and comments: PatientSafetyBeat@BetsyLehmanCenterMA.gov