March 14, 2023
The Health Care Improvement Foundation’s (HCIF) Partner Profiles highlight the efforts of valued and innovative health leaders. Our partners’ work supports HCIF’s vision of healthier communities through equitable, accessible, and quality health care.
As HCIF celebrates Patient Safety Awareness Week (March 12 – March 18) this month, we’re excited to feature one of the longest-standing members of HCIF’s Clinical Advisory Committee, Dr. Charles Wagner of Redeemer Health. Learn more about how he applies patient safety principles to his everyday life, what changes in patient safety he’s witnessed throughout his career, and what he sees as the most important future priorities in patient safety. This conversation has been edited and condensed.
Charles I. Wagner, MD, FACP currently serves as the Medical Adviser for Patient Safety and Quality at Redeemer Health in Meadowbrook, PA. He has practiced gastroenterology in academic and community based settings and has served as the Chief Medical Officer and Patient Safety Officer at Redeemer Health. He is a member of the Clinical Advisory Committee of the Health Care Improvement Foundation and had served on the Board of Directors of the Pennsylvania Health Care Quality Alliance.
As a long-standing member of HCIF’s Clinical Advisory Committee since its inception, you’ve contributed to a number of the Partnership for Patient Care (PPC) programs. During your time as an advisor, in what ways do you think that PPC has helped advance quality and patient safety across the region? What is something you’ve learned through working with our organization?
It’s been a remarkable adventure to serve as an advisor and working in the patient safety space has opened my eyes a lot. There are patient safety principles that we use all the time in our everyday lives that you don’t really think about. Ultimately, though, it comes down to patient safety being a way to help people and prevent problems. The real advantage of HCIF and PPC is that we all want to do the same thing and doing it together has lots of advantages. For example, it combines the work allowing for organizations to share their experiences and move things faster. It also allows for institutions to provide care to their patients in their community through the full spectrum of their experience. Lastly, it allows for common definitions and approaches to be used by everyone.
Early on in my career as Chief Medical Officer, there were numerous requirements from regulatory bodies that wanted hospitals to look at many metrics. We developed a patient scorecard and thus began a big effort to standardize amongst ourselves and try to convince regulatory bodies to use the same indicators so there was common definitions and terminology. That’s also the kind of thing HCIF became useful in. For example, when we first started looking at falls, everyone had different definitions of what constituted a fall and how to respond to it. We adopted a common terminology that was used across the country and could then compare rates better. When you don’t have that common definition, it becomes problematic, and we saw that with COVID-19.
“There are patient safety principles that we use all the time in our everyday lives that you don’t really think about. Ultimately, though, it comes down to patient safety being a way to help people and prevent problems.”
Charles Wagner, MD
HCIF is celebrating Patient Safety Awareness Week from March 12-18, 2023 this year. Given your expertise, work, and advocacy in patient safety, what are some of the most significant changes or evolutions of patient safety that you’ve witnessed during your tenure?
I think that probably the most important factor is we’re now actively talking about and prioritizing Patient Safety. For a long time, we didn’t talk about it, and individually we had been aware of some problems, but we weren’t collectively collaborating or educating about them. The more people that are aware of patient safety, the more attention they can pay to helping prevent future problems.
Another important thing that has occurred is we’ve gotten patients involved in patient safety. By including and empowering them in their care, we’re asking for their help to identify problems. We’re aware that patients are a last step in preventing problems, such as double checking they are the right person to receive a certain surgery, or that they are receiving the correct medication. Patient involvement is crucial to the whole process of patient safety. One of the things [Redeemer] was recognized for years ago was about infection prevention regarding handwashing. We put a sign in every patient’s room that read “Did you ask your caregiver to wash their hands?” This allowed the patient to be an active participant in their care and put staff on notice that they were going to be asked if they washed their hands. Redeemer had such a successful initiative that our work got picked up by the local news and made its way to national news. This initiative helped educate the population about something as simple as handwashing and everyone’s involvement in doing that.
Lastly, it’s important to emphasize that everybody has a role that contributes to and makes up the bigger picture of patient safety. Having everybody involved—everyone from patients, nurses, clinicians, dieticians, cleaning staff—helps reinforce behavior and creates a culture of safety.
Looking ahead, what is something that excites you about where the field of patient safety is headed?
A crucial step along the way in the future of patient safety is understanding our own behavior. It’s important to understand how people think and act in order to anticipate what steps we may need to take in response to actions. The behavioral stuff of how we learn and how we respond, it’s everywhere in our lives. I spent time in the U.S. Public Health Service that provided health service to the U.S. Coast Guard, and from that experience I took away learnings of how the military practiced and completed drills in preparation for problems they may have encountered. I witnessed how everyone on the team had their assigned job and I was able to draw many parallels to the very same concepts of education, practice, and accountability that we carry out in health care.
Along those same lines, another big insight I had occurred when I started at a new institution during my graduate training and found that they were not doing things the same way I did or was taught. I realized that I was inculcated with the behavior and institutional approach of the people that previously taught me and worked with. When I went to another institution that had a different orientation or culture—it wasn’t a matter of who was right or wrong, but rather an opportunity to interface with and learn from each other. That same principle applies to the cross-fertilization that HCIF’s work promotes. As each institution learns about a safety issue or solution, sharing it or exchanging that information in collaboration with someone else has real value to it.
As you reflect on your career of being a health care provider and patient safety expert, how did you become interested in patient safety? What do you think is one of the most compelling or important components of patient safety that the general public might not yet know?
Paired with the landmark report “To Err is Human: Building a Safer Health System” from the Institute of Medicine in 1999, and witnessing things happen in the clinical setting, I realized how important patient safety was. From there and serving as Chief Medical Officer, I was involved in writing our organization’s first Patient Safety plan.
Two of the big tenents of patient safety is communication—we have to make sure we’re talking the same “language”—and education. Additionally, as I shared before, we have to keep in mind the human behaviors behind actions. Knowing how we react and what we do and why is really crucial. It’s important to understand what people are working with and why they’re reacting a certain way when you are educating and training them, especially as it applies to health care. Addressing the components of communication and education can ultimately have a profound impact on the outcomes of care and culture at an organization.
If you are interested in connecting with our partner, you can connect with Dr. Wagner via email at Cwagner@holyredeemer.com.
Something you may not know about Dr. Wagner…
His favorite book is Moby Dick, which he first read in high school and when the movie came out, he saw it fifty-six times while working as an usher in the movies! When reading Moby Dick, Dr. Wagner likes to reflect on what a case study of patient safety the story is. He draws parallels of the actors, actions, and lessons learned in the story to that in health care and appreciates looking at all those aspects of behavior, safety, and leadership in just one story.
Additionally, Dr. Wagner likes to garden as a hobby and form of exercise. With the help from his wife, he sees the everyday tasks of gardening following the same steps of a Plan, Do, Check, Act quality cycle. As he’s shared throughout this profile, he likes to seek and apply patient safety principles to his every day when he can!