Dismissing Patient and Caregiver Concerns Tops Annual List of Patient Safety Threats
might produce,” he says.“ For example, we are generally not rude with other people in everyday conversations, because we’ re given immediate feedback. We see the immediate harm. Infections are different. It’ s very hard to see the link between not washing hands and the downstream infection that might occur, just as it’ s hard to see the link between not signaling a lane change on the highway and the automobile accident that might result.”
Marx continues,“ Having a strong culture without that immediate feedback mechanism takes effort, with both managers and peers reinforcing the good behavior. We have to do the right thing, knowing that it‘ statistically’ helps. And when we see a colleague beginning to drift, we need to feel the psychological safety to help, to be‘ my brother and sister’ s keeper,’ as the saying goes. Without a strong culture, the work of infection prevention can easily be out-prioritized by more other tasks.”
Marx says the same logic applies when ensuring that organizational culture supports efforts to uphold patient safety.
“ Safety events are relatively rare,” he says.“ However, even within a good system, without feedback, we humans are apt to drift. Consider airline crashes or collisions, for example. They are very rare, statistically, and as a result, it’ s easy for system designers and those operating with the airspace system to drift into riskier and riskier choices over time. We’ ve seen tragic examples of that recently. Think of culture as being our collective choices. Yes, we are human, so we’ re going to make unintended mistakes along the way. Yet, it’ s the quality of our choices that really represents our culture. How much at-risk behavior is present in our work? How much have we drifted away from what was possible? Tending to culture is half of the managerial task, designing safety systems the other half. Both are required in an effort toward zero harm in patient care or high reliability.”
Taking Measure of Your Facility’ s Safety Culture
The Agency for Healthcare Research and Quality( AHRQ) explains,“ As hospitals continually strive to improve patient safety and quality, hospital leadership increasingly recognizes the importance of establishing a culture of patient safety. Patient safety culture refers to the beliefs, values, and norms shared by healthcare practitioners and staff throughout the organization that influence their actions and behaviors. Patient safety culture can be measured by determining what is important and what attitudes and behaviors are rewarded, supported, expected, and accepted, with regard to patient safety. It is important to broadly establish a culture of patient safety because it exists at multiple levels: within healthcare systems, hospitals, departments, and units.”
Want to measure your own institution’ s culture of safety? AHRQ makes available its Surveys on Patient Safety Culture ®( SOPS ®) Hospital Survey for providers and other staff to assess patient safety culture in their hospitals. In 2019, AHRQ released a new version, the SOPS Hospital Survey 2.0, and it offers two types of measurements. The first one is composite measures, which is a grouping of survey items that assess the same area of
Dismissing Patient and Caregiver Concerns Tops Annual List of Patient Safety Threats
Dismissing patient, family, and caregiver concerns tops ECRI’ s
2025 list of the most significant threats to patient safety. The global healthcare safety nonprofit organization says time and resource constraints make it increasingly difficult for some clinicians to provide empathetic care that addresses patient and caregiver concerns, potentially leading to missed and delayed diagnoses.
More than 94 % of patients reported instances when their symptoms were ignored or dismissed by a doctor, according to a survey from HealthCentral. ECRI says when concerns go unaddressed, patients and caregivers feel like they’ re experiencing“ medical gaslighting,” which the American Journal of Medicine defines as“ an act that invalidates a patient’ s genuine clinical concern without proper medical evaluation.” Unlike the popular usage of the term“ gaslighting,” medical gaslighting is not considered intentional, and clinicians are often unaware they exhibit the behavior, ECRI experts say.
ECRI says medical gaslighting can happen when clinicians are rushed for time, have biases that reflexively attribute symptoms to issues like mental illness, age, or weight, or make cognitive errors like interpreting new information in a way that confirms a previous diagnosis. This can lead to a missed diagnosis, delayed treatment, and decreased trust between patients and their healthcare providers.
“ Most clinicians have a deep commitment to healing and protecting their patients and would never intentionally make a patient feel unheard, but it nevertheless happens with alarming frequency,” says Marcus Schabacker, MD, PhD, president and chief executive officer of ECRI.“ Providing high-quality healthcare starts with truly listening to patients. When we value their input, we gain critical insights that improve patient outcomes and build trust. A healthcare system that prioritizes patient voices is one that delivers safer, more efficient, and more compassionate care for all. Unfortunately, too many clinicians are operating under time and resource constraints that fuel substandard care.”
ECRI experts say solutions require a holistic approach that considers how all aspects of a health system— including leadership and governance structures, patient engagement, workforce wellness, and training infrastructure— promote safety.
“ Patient safety events are not isolated incidents. They are often products of the system that clinicians and patients operate within, and how that system supports the people it serves,” says Shannon Davila, MSN, RN, CPPS, CIC, CPHQ, FAPIC, executive director of total systems safety at ECRI.“ Tackling threats to patient care requires rejecting the current fragmented approach and designing systems that promote a true culture of safety.”
ECRI’ s report provides similar systems-based solutions for each of the top 10 concerns. The 2025 concerns in ranked order are:
1. Dismissing patient, family, and caregiver concerns 2. Insufficient governance of artificial intelligence 3. Spread of medical misinformation 4. Cybersecurity breaches 5. Caring for veterans in non-military health settings 6. Substandard and falsified drugs 7. Diagnostic error in cancers, vascular events, and infections 8. Healthcare-associated infections in long-term care facilities 9. Inadequate coordination during patient discharge 10. Deteriorating working conditions in community pharmacies
ECRI’ s 2025 report includes recommendations for healthcare organizations to create organizational resilience to navigate the identified threats and strive for total systems safety.
22 • www. healthcarehygienemagazine. com • mar-apr 2025