Against the Odds, Hospitals Are Getting Safer

Hospitals are performing better on quality and safety metrics than they did pre-pandemic, despite seeing sicker patients—and more of them.

That’s according to a new report from the American Hospital Association and Vizient, a health care performance improvement company. The organizations analyzed data from Vizient’s Clinical Data Base, which contains information from more than 1,300 hospitals and collects data on more than 10 million inpatients and 180 million outpatients each year.

In the first quarter of this year, hospitalized patients—despite facing more acute, complex health issues—had a survival rate over 20 percent higher than anticipated based on the severity of their conditions compared to the fourth quarter of 2019, per the report.

Between April 2023 and March 2024, the analysis found 200,000 patients who survived health episodes that likely would have been fatal in 2019. Mortality rates and hospital-acquired conditions, including central line-associated bloodstream infections and catheter-associated urinary tract infections, have decreased over the past five years.

The report comes at an interesting time, as hospitals are entering a “new era of ‘normal’ operations” in the wake of COVID-19, Dr. David Levine, chief medical officer at Vizient, told Newsweek.

“This study allowed us to show that things are back on track,” Levine said. “Not to say we’re anywhere near declaring victory, but that improvement that was going on before 2019 has regained its momentum.”

Prior to March 2020, hospitals had been making steady gains on patient safety metrics. The pandemic threw a wrench in that progress by straining capacities, disrupting supply chains and severing health systems’ physical connections to their patients. People delayed nonemergent procedures and routine screenings for fear of catching COVID—which could be one reason why patients are presenting with more severe illnesses now.

The pandemic took a toll on health care organizations’ budgets, too. The American Hospital Association estimated that the nation’s hospitals and health systems forfeited $202.6 billion from March 1, 2020, to June 30, 2020, or $50 billion per month on average, both from lost revenue and additional COVID expenses.

One of the most persistent issues has been the workforce shortage. Approximately 100,000 nurses left the profession during the pandemic, according to the National Council of State Boards of Nursing. Many of them were older, experienced nurses who couldn’t ignore the risks COVID posed to them. This Great Retirement took not only bedside clinicians, but “a lot of our institutional memory,” Dr. Tracey Hoke, chief of quality and performance improvement at UVA Health, told Newsweek.

Dr. Steven Diaz, chief medical officer at MaineGeneral Health, tells a similar story. Since Maine has the oldest average population of any U.S. state, many of the health system’s nurses had been working there for decades, and some were bordering on retirement age. When COVID catalyzed their exit, new nurses replaced them—but they didn’t have the same organizational pillars to learn from as their predecessors.

Health systems relied on travel nurses to fill staffing gaps, but heightened demand made it costly. During January 2021, travel nurses made as much as 3.4 times the wages of full-time nurses, the Advisory Board reported. Hospitals couldn’t compete with that type of pay, so they lost nurses to travel contracts; it was a “major upheaval,” according to Diaz.

“To be quite honest, we all struggled a bit with quality during those years, and a large part of it had to do with staff turnover,” Diaz said.

In the aftermath, the Augusta, Maine-based health system set the goal to return to a steady workforce. When the same teams work together every day, it’s easier to ensure that everyone knows the rules—plus, it’s easier to enforce them in tight-knit groups. The organization has “Speak Up” and “Great Catch” awards that reward people for speaking up when something seems amiss.

Charlottesville, Virginia-based UVA Health had similar ambitions, according to Hoke. The health system brought on travelers to maintain its nurse-to-patient staffing ratios during the pandemic. Lately, it’s been working to convert as many contract nurses as possible into full-time workers.

To do so, the health system has to create a culture where people want to plant roots, Hoke said. It’s leaning into a “high reliability” management system, defined by the Agency for Healthcare Research and Quality as “organizations that operate in complex, high-hazard domains for extended periods without serious accidents or catastrophic failures.”

“Every hospital in America is trying to run a high reliability system,” Hoke said. “It takes this culture of asking for help, and [establishing] it’s OK to ask for help. It’s also OK to call out a risk and say, ‘Wait, I think this is unsafe. We shouldn’t do it,’ or, ‘Did we check the armband for the ID twice like we’re supposed to?'”

Since many of UVA Health’s hires are recent graduates, the health system has set simple, straightforward expectations. For example, “These are the five things you need to do every single time you interact with a central line.” If a nurse doesn’t have the tools for step three or doesn’t remember how to do step five, they can clearly and concisely ask for help.

Diaz has also noted generational differences at MaineGeneral. Younger nurses are more apt to use shorthand and acronyms that their colleagues can’t always translate. The health system has focused on direct communication and revisiting the standard scripts for interactions with patients and families.

The organization also asks staff to refrain from using their phones while walking, and instead to make eye contact and smile—but above all, to be attentive.

Close-knit, proactive teams yield better results, according to Diaz. He compares health care teams to Indy 500 pit crews; the more the crew trains together and understands each person’s role, the better their outcome is likely to be.

By focusing on retention and frequently revisiting training for travelers and newer hires, the health system has lowered infection rates that rose during the pandemic.

“When we had a lot of turnover and the teams did not know each other, we had to do more review and reorientation and get back to our standard work so that everybody felt empowered to speak up and knew what the rules were,” Diaz said. “We really just focused on the basics.”

A clear, aligned organizational vision is characteristic of high-performing health systems, according to Levine. During a visit to one top hospital, the Vizient executive shared an elevator with a patient transporter who instructed him to use hand-sanitizing gel upon exiting. The staff member wasn’t hired to lead infection control efforts, “but he understood the importance of his role in health care and how he contributed,” Levine said.

Health systems are breaking down external silos, too. UVA Health and MaineGeneral share data, processes and protocol with Vizient so other organizations can benefit from the pooled insights.

“Right now, the culture amongst quality officers is that we’re all happy to share, because this work is hard enough as it is,” Hoke said. “If we were fighting each other, it would be impossible.”

That collaborative culture has allowed for widespread improvements in patient safety, Levine said. He was surprised by the diversity of hospitals that saw better scores, from small community hospitals to large academic medical centers. Data utilization has improved since the pandemic, but so has the availability of data.

Beyond data sharing, hospitals can connect with each other in real time to make difficult clinical decisions. Telepresence advancements have given rural areas access to physician specialists, according to Dr. Chris DeRienzo, chief physician executive of the American Hospital Association.

Dr. DeRienzo saw this in practice at a small critical access hospital in the Midwest. The hospital has four on-staff physicians and a number of advanced practice providers—sufficient for its day-to-day operations, but not for the occasional severe trauma patient. Now, when a highly complex patient comes in, the hospital can quickly access a board-certified emergency physician to walk them through the case remotely.

Hospitals are still tending to many pandemic-induced pain points, but the struggles don’t tell the whole story, according to DeRienzo. He hopes that health care workers will see the report as a testament to how far they’ve come—and that patients will be heartened by a fleck of good news.

“Yes, we were heavily deployed to solve all of the new challenges that COVID presented us,” DeRienzo said. “At the same time, the two driving forces of improvement and innovation continued, and that’s what you see in this report.”