Our next topic is safety. I want to be able to distinguish the term safety from the term quality. They're very different concepts. Both are important, but they are different. The term safety means freedom from those conditions that cause death, injury, illness, damage to or loss of equipment or property, or damage to the environment. That's a definition that's provided by the National Patient Safety Foundation in the reference at the bottom of your screen. As safety increases, does quality also increase? You may be tempted to say yes, but that's not necessarily true, because there are different concepts. Now, I've already talked about the situation where quality and safety go in opposite directions in the case of a climber. Let me now give an example of where safety and quality can go in opposite directions in the setting of healthcare. There's no such thing as a drug that is completely safe. Every time we use a medication, there's a potential for harm. So, in the scenario where we want to make therapy more appropriate by adding a drug, the quality goes up, because it's more appropriate, but safety could go down. So, as soon as where appropriate therapy is used, the quality goes up, but safety goes down. Appropriate therapy and efforts to make it as safe as possible also need to be affordable. As an example, we might argue that the safest most appropriate thing to do is to have a dedicated pharmacist, nurse, and physician for every patient. That might provide the safest care, but we sure as heck could not afford that. So, all therapies need to be optimally safe, have optimal quality, and be affordable. We're always looking for those three different elements. Here's a Venn diagram to make that point more clearly. So, in one sphere, we've got safety there, appropriateness is in that circle, and affordability is there. Well, what we're doing is we're looking for the sweet spot, that part in the middle that balances safety, appropriateness and affordability, and I'd like to call that quality because where that sweet part is, uses judgment. It can be subjective, but that's what we should be striving for, for each of our patient interventions. Safety focuses on preventing adverse events, where quality focuses on doing the right things and doing them well. It's very important to understand that those are two very different principles that we want both of them, and we also need to be able to afford what we've picked. The Institute of Medicine had a really important publication back in 2001 called Crossing the Quality Chasm. And in the introduction to their book, they were making a comment about healthcare in general, and they make the statement that between the healthcare that we now have and the healthcare that we could have, lies not just a gap, but a chasm. I suspect we still might argue some many years later that that's still the case. They then provided a number of very important goals or aims in providing healthcare, and they also stressed the importance of all of us in healthcare having shared vision to achieve those aims. There are six aims. One involves safety, and five involve quality. Safety, we want to avoid injuries to patients from the care that is intended to help them. Now, understand that sometimes an injury, like radiation therapy, may be justified given what we're trying to accomplish. So, if we do cause an injury, like through surgery, we always want to make sure that the good is better than the harm. They also have a number of other items that stress quality. The therapy should be effective. It should be patient centered. We should involve the patient in the decisions for their healthcare, and we should try to work with the patient so that they don't have to go too far out of their way to get that care. It should be timely. We shouldn't have somebody wait for months and months to get needed therapy. It should be efficient, so it can be affordable, and it should be equitable. The care needs to be provided for all those who need it. So, those should be our shared vision and our shared aims in providing healthcare, and provides a really nice structure for comparing safety and quality.
