Letter from Barbara Fain,
Executive Director

The prosecution of health care professionals for mistakes in patient care is exceedingly rare. The recent negligent homicide conviction of nurse RaDonda Vaught for a medication error at a Tennessee hospital has provoked considerable consternation from frontline clinicians to patient safety groups (including IHI/LLI and ECRI/ISMP) and underscores our need to reframe the dialogue in order to advance, not erode, safety ...


Among other efforts to address racial inequities in medical care, organizations should examine how patient safety events are reported, according to ECRI, a research and risk management firm that issues a well-known annual Top 10 list of patient safety concerns. Bias and racism in addressing patient safety is #3 on ECRI's list for 2022. That designation is based on data from a national Patient Safety Organization plus a few recent studies that demonstrate racial bias in reporting by comparing automated systems with voluntary provider reporting.

Two years after the initial U.S. response to COVID-19 revealed systemic gaps, the Association for Professionals in Infection Control and Epidemiology translates lessons learned about all aspects of infection control, including equipment, staffing, data collection, vaccination, and more, into a series of steps to be taken now to prepare for the next pandemic. 

In Between a Rock and a Hard Place: Recommendations for Balancing Patient Safety and Pandemic Response, APIC recommends that provider organizations include at least one infection preventionist on emergency response or incident command teams, run drills and scenarios for various communicable disease situations, and promote interdepartmental collaboration for cleaning, disinfection, and sterilization during a pandemic. APIC’s suggestions for policymakers include sponsoring “just-in-time” education and training in infection control across the health care workforce during a pandemic, incentivizing the next generation of infection prevention and control professionals, and funding the development of innovative personal protective equipment. 
Upcoming events
April 28
12 - 2 p.m.
Risky Business: In the Red Zone. Boston Children's Hospital offers the next virtual event in the Risky Business conference series. Physicians in Western Ukraine, workers on the frontlines of the pandemic, and board leaders will share their experiences and crisis management successes. Register here
May 12
1 - 3 p.m.
What Patients Are Saying: Insights About Primary Care From MHQP's Statewide Patient Experience Survey. Exploring how data from the Massachusetts Health Quality Partners' patient experience survey can be used to drive measurable improvements. Register here
May 18
12 p.m.
Disparities in Maternal Health: Connecting Community Advocacy to Clinical Practice. A new state commission plans to recommend policies to redress racial disparities and promote equity in maternal health outcomes. Register here
June 2
9:30 a.m. -
12 p.m.
Part 2 of the 9th Annual Communication, Apology, and Resolution (CARe) Forum. An interactive event including testimonials, case study simulations, and group discussions about best practices for communication and resolution programs. Free and open to all. Learn more
Patient Safety Beat is published by the Betsy Lehman Center, a Massachusetts state agency that supports providers, patients and policymakers working together to advance the safety and quality of health care.