RamaOnHealthcare July 13, 2023
We could do better. Much better!
Today, RamaOnHealthcare talks with Dr. Karen Wolk Feinstein the President and CEO of the Jewish Healthcare Foundation in Pittsburgh, PA. She has worked with reducing medical error for more than two decades, has received the NBME Edithe J. Levit Distinguished Service Award, supports activist philanthropy, and is actively involved in reducing the flow of RNs leaving hospital settings.
Dr. Karen Wolk Feinstein, President and CEO, Jewish Healthcare Foundation (JHF)
RamaOnHealthcare (ROH): The Jewish Healthcare Foundation, which you have led since its inception more than 30 years ago, has been making an impact in your region and beyond through what you refer to as “activist philanthropy.” To what key areas of focus have you applied this activist mindset?
Dr. Feinstein (KWF): The activist mindset seeks to develop strategic directions that target a medical issue, systems problem, or aspect of common medical practice under the rubric of “We could do better. Much better!” The objective is to identify better policies, behaviors, or practice guidelines and prove that they will improve health status, and then communicate the findings widely. We have largely been focused on strategic directions regarding women’s health, HIV/AIDS, senior care, teen mental health, and patient safety.
ROH: Health care has experienced periods of reductions in medical error but has yet to see sustained improvements over time. Evidence continues to show declines in patient safety since the start of the COVID-19 pandemic. Where are the greatest opportunities for making lasting improvements to patient safety today?
KWF: Patient Safety should be at the top of every healthcare organization’s priority list. Whatever strategies we pursue, we must take the burden off the frontline and not add additional tasks, or we’ll have even more retirements and resignations that are exacerbating the problem. Turning to technology, we can introduce the kind of autonomous safety nets that are present in other complex, high-risk industries.
Patient Safety should be at the top of every healthcare organization’s priority list…. Turning to technology, we can introduce the kind of autonomous safety nets that are present in other complex, high-risk industries.
ROH: How do you see AI having the most beneficial impact within health care, and what do you say to those who have reservations about its use?
KWF: I look to broad data mining, analytics, and surveillance systems that allow us to identify the preconditions for harm, test or simulate solutions where we observe a “hot spot,” rapidly communicate the successful interventions, and develop autonomous systems for early detection, intervention, and prevention. I say to doomsday believers: airbags have risks, designated drivers can have mishaps in unfamiliar vehicles, and bike brakes occasionally fail. But they all save millions of lives. AI can augment our workforce capacity in desperately needed areas. Technology can continuously improve, but not if you nix it before it’s deployed.
I look to broad data mining, analytics, and surveillance systems that allow us to identify the preconditions for harm….
ROH: A few healthcare systems are implementing innovative solutions, such as command centers to identify and respond in real-time to address operations, staffing, and other critical components of safe care. Thus far these successes remain siloed, with no real mechanism for learnings to spread. What will it take for the industry to benefit from the advances made by organizations that are committed to improving safety?
KWF: It’s time for the leaders of our mega health systems to do what the leadership in other high-risk, complex industries have done: come together across competitive boundaries to share data, invest in safety research, subsidize a powerful safety net, and share best practices and expertise. Also, it is past time to establish an independent national patient safety board to ensure research is interdisciplinary, ongoing, widely disseminated, and where reasonable, enforced.
…establish an independent national patient safety board to ensure research is interdisciplinary, ongoing, widely disseminated, and where reasonable, enforced.
ROH: The Biden Administration designated five cities, including your organization’s home of Pittsburgh, as workforce hubs. What do you see as the potential for regional efforts like this to spark innovation in healthcare and patient safety and alleviate the crisis facing the healthcare workforce?
KWF: The research needed to transform healthcare must be interdisciplinary. It will require regional (and national and even global) open-source—but protected—collaborations among leaders in AI/ML, robotics, life sciences, human factors engineering, safety science, informatics, medicine, and other disciplines. It should include academics, lab scientists, practitioners, entrepreneurs, etc. I see great potential if the needed experts can escape from their silos. The Anesthesia Patient Safety Foundation is a fabulous example!
ROH: What are three things that healthcare leaders can do today to make meaningful changes for patient and workforce safety?
KWF: I’ve touched on this in the need for collaboration across health systems and interdisciplinary research, but I’d add: 1. Make vendors and suppliers accountable for product safety. 2. Train and educate healthcare professionals in safety science, quality engineering, systems theory, and human factors engineering. 3. In every decision, action, appointment, and promotion—make it clear to your organization that safety is your #1 value. Collect and share reliable data on interoperable systems!
…make it clear to your organization that safety is your #1 value.
ROH: You’ve been challenging the status quo in health care for decades. What continues to motivate you in this work?
KWF: The other people working to reform our systems; the advocates who’ve lost loved ones to medical error; the patients living with unnecessary disabilities from healthcare harm; and the amazing accomplishments of modern technology.
ROH: Lastly, what advice do you have for the healthcare leaders of tomorrow?
KWF: No one compelled you to take on the challenge of running a medical system. You have a moral obligation to keep your workforce and patients safe. Take leadership within your industry and commit to reducing medical error by 80% in five years.
Take leadership within your industry and commit to reducing medical error by 80% in five years.
Personal interests: Dr. Feinstein enjoys cycling, hiking, kayaking, cross-country skiing, and Broadway musicals.