Medical errors kill thousands of people each year. But are hospitals getting any safer?

Two years ago, administrators and caregivers at St. Bernard Hospital in Chicago were stunned when they flunked a basic standard for patient safety.

"It was a real jolt," said Charles Holland, the hospital's president and CEO. "We thought we were doing patient safety and we thought we were doing it well."

But the Leapfrog Group, a nonprofit health care watchdog organization, found the hospital fell short on documenting and having comprehensive approaches to hand-washing, medication safety systems and fall and infection prevention.

The wake-up call led Holland to hire a Patient Safety and Quality Officer and to use Leapfrog's criteria as a roadmap for improving patient safety.

It worked. In its latest annual review of hospital safety, released Wednesday, Leapfrog awarded the century-old charity hospital an A.

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The fact that St. Bernard could turn around so quickly and so effectively without spending a fortune in the process shows that patient safety is an attainable goal, said Leah Binder, Leapfrog's president and CEO.

"I'm incredibly inspired by St. Bernard's," Binder said. "This is a story of a hospital that has every reason to give excuses and instead gave us extraordinary performance."

For decades, hospitals have paid lip service to patient safety, but the numbers tell a different story. In 1999, an Institute of Medicine report called "To Err is Human" found medical errors cause as many as 100,000 deaths per year.

A 2017 study put the figure at over 250,000 a year, making medical errors the nation's third leading cause of death at the time. There are no more recent figures.

But the pandemic clearly worsened patient safety, with Leapfrog's new assessment showing increases in hospital-acquired infections, including urinary tract and drug-resistant staph infections as well as infections in central lines ‒ tubes inserted into the neck, chest, groin, or arm to rapidly provide fluids, blood or medications. These infections spiked to a 5-year high during the pandemic and remain high.

"Those are really terrible declines in performance," Binder said.

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Not all patient safety news is bad. In one study published last year, researchers examined records from 190,000 patients discharged from hospitals nationwide after being treated for a heart attack, heart failure, pneumonia or major surgery. Patients saw far fewer bad events following treatment for those four conditions, as well as for adverse events caused by medications, hospital-acquired infections, and other factors.

It was the first study of patient safety that left Binder optimistic. "This was improvement and I've never ever, ever seen that," she said.

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Binder attributes the advances to federal reporting requirements that forced hospitals to reveal patient safety metrics, such as how many people were catching infections in hospitals and how many patients were falling out of bed or not being turned enough to avoid pressure sores. Those metrics allowed Leapfrog and others to grade hospitals on their performance.

As a result, hospital board members started asking their leadership teams, "why are we are getting a C or a D or an F? How could you not tell us what was happening?" Binder said. "That moved patient safety up on the CEO's priority list. Fast."

Unfortunately, the pandemic un-did a lot of that progress.

With the increased demands on staff during the pandemic, compounded by burnout, staffing and supply shortages and high turnover patient safety slipped as a priority, Binder said.

"Hospitals are supposed to be caring for patients and keeping them safe no matter what, even in an emergency," she said. "That is why we have hospitals, because emergencies happen. We expect them to be able to handle them."

According to Leapfrog's latest ranking, over 800 hospitals ‒ nearly 30% ‒ received an A, a slight drop since before the pandemic. More than 700 ‒ or 26% ‒ received a B; 1,100 ‒ or just under 40% ‒ received a C, a small uptick; 170 or 6% were given a D; and 12 hospitals, or less than 1%, flunked.

The state with the most A hospitals is New Jersey, which jumped from No. 6 to No. 1 since the Leapfrog's last review. Delaware, North Dakota and Washington, D.C., are tied at the bottom of the ranking, entirely lacking A-rated hospitals.

On any given day now, 1 of every 31 hospitalized patients acquires an infection while hospitalized, according to a recent study from the Centers for Disease Control and Prevention. This costs health care systems at least $28.4 billion each year and accounts for an additional $12.4 billion from lost productivity and premature deaths.

"That blew me away," said Shaunte Walton, system director of Clinical Epidemiology & Infection Prevention at UCLA Health. Electronic tools can help, but even with them, "there's work to do to try to operationalize them," she said.

The patient experience also slipped during the pandemic. According to Leapfrog's latest survey, patients reported declines in nurse communication, doctor communication, staff responsiveness, communication about medicine and discharge information.

Boards and leadership teams are "highly distracted" right now with workforce shortages, new payment systems, concerns about equity and decarbonization, said Dr. Donald Berwick, president emeritus and senior fellow at the Institute for Healthcare Improvement and former administrator of the Centers for Medicare & Medicaid Services.

"There a long list of things now on the agenda," Berwick said. "Safety, if it hasn't fallen off the list, it's certainly lost rank."

Why these problems keep happening

To some extent, hospital safety is a no-brainer.

It's been clear for almost 200 years that dirty hands and medical equipment can transmit infections. Technological advances and training on basic habits can make a difference.

"We have really good evidence about things that work," Binder said. "What we haven't had is that shove to hospitals to say 'now go do it.'"

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Patient care has also become increasingly complex over the past two decades and if nothing had been done about patient safety, "the number of errors and deaths from errors would be far higher," said Dr. Robert Wachter, chairman of the department of medicine at the University of California, San Francisco.

But he admits that the field has stagnated over the past decade as other priorities, such as patient satisfaction, caregiver burnout and equity, have competed with patient safety for attention and scarce dollars. "The agenda has grown and grown."

Hospitals did the easy stuff first, the "incredibly, almost flabbergasting errors where we'd do surgery on the wrong patient," Wachter said. "We don't do as many of the really, really bad, 'how could that possibly happen?' things. The errors today are more subtle, but they're actually more difficult to eradicate."

Changing a hospital's culture is the hardest part of addressing patient safety, said Dr. Elizabeth Mort, senior vice president for quality and safety at Massachusetts General Hospital, one of the researchers who led a recent study on patient safety at Harvard-affiliated hospitals. Workers have to be encouraged to do the right thing and supported for it.

Serious mistakes are usually the product of systems or basic habits that don't support appropriate behavior.

"Sometimes it's the simple things that are the best things," Mort said.

She pulled up a sign that was posted next to patients getting infusions, reinforcing the "5 rights." "Is it the right person, is it the right drug, is it the right dose, is it the right time, is it the right route?"

Surgical teams should also be pausing for a "pre-operative timeout" before they begin, to make sure they have the right patient and right body part identified.

"Each and every time. There's no excuse not to," Mort said.

A culture of openness, awareness and inclusion, where employees feel empowered to raise questions is "a big part of the solution to safety," Berwick added.

Having electronic systems in place, like bar codes on both patient wristbands and medications, can also help avoid mistakes.

Electronic medical records have made it easier to avoid mistakes like giving a patient a medication they are known to be allergic to ‒ but caregivers are subject to so many alerts they can get "pop-up fatigue" and miss important messages, Mort said.

Technical solutions aren't enough, said Stephanie Mercado, chief executive officer and executive director of the National Association for Healthcare Quality. Health care executives have to invest in training their workforce to move the needle on patient safety.

"It's the single biggest lever they have to affect change," she said.

Today's safety training is highly variable and often absent from workforce development plans, said Mercado, whose organization offers a standardized and specific framework for improving patient safety and quality. About half the 14,000 professionals involved in safety and health care quality don't have funding from their employers for training and have to scramble to self-fund their training programs, she said.

Too many hospital leaders "view quality as compliance," she said, responding to mistakes that are made instead of proactively making improvements to insure safer care.

Caregiver burnout is closely tied to patient safety, Mercado said. "Burnout occurs in part because the workforce sees the same challenges in health care quality and safety playing out over and over and over again."

The health care payment system doesn't help. Short of a truly egregious error, a hospital gets paid for a procedure whether the "care was perfect or not," Wachter said.

"No one has figured out yet a system that provides appropriate incentives on either quality or safety," he said. "Most health care organizations want to do the right thing but the kind of investment that has to go into people and processes to really address this adequately is pretty high."

Patients can help themselves by coming to the hospital with a list of medications they're taking and any allergies.

It's also "fair game" to ask a caregiver to wash their hands when entering a patient's room, Mort said, and to make sure they are being given the correct medication and that they understand it's effects and possible side effects. "If something doesn't seem right, speak up," she said.

And it makes sense for patients to bring someone with them, "another set of eyes and ears," Mort said, because it's hard to pay attention to such things when you're feeling lousy.

But the burden shouldn't be on the patient to keep themselves safe in a hospital, Mort said. "It's really our responsibility to implement these systems and do the right training."

Hospitals can turnaround

When Michael Richardson was first hired at St. Bernard as Patient Safety and Quality Officer, he said his focus was to make changes that would show progress quickly.

He helped establish a committee on safe medication administration, corrected systems issues with digital systems, replaced damaged equipment and began to use existing resources to provide more data on patient safety measures.

"Straight away we could see a difference," Richardson said.

He also purchased a system from the company BioVigil, providing badges that flash yellow during the first minute a caregiver is in a patient room and then red if they haven't washed their hands. Both Richardson and Holland pointed to their shoulders on a recent Zoom call, displaying their green-lit badges.

Compliance with handwashing is now around 90%. "It sends a good message to the patients," Richardson said, plus it enables the administration to track which staff members and physicians are keeping their hands clean.

Rather than punishing people for making mistakes, the administration now recognizes employees' good work and tries to encourage workers to speak up if they see a problem. "If they don't tell us, we can't fix it," Richardson said. "We're still trying to change that culture."

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Holland said he's also changed his language when he speaks with physicians and his own leadership team.

"I talk about patient safety more," he said. "I address an issue as it relates to patient safety. Before I may have said that's part of the standard or a quality issue, but now I relate it more directly to keeping a patient safe."

Safety-net hospitals like his, where nearly 80% of patients are covered by Medicaid, need additional resources to focus more fully on patient safety. His patients deserve the same standards of safety as people and communities with more economic advantages.

The A grade is a major accomplishment and the hospital is hosting a cupcake celebration Wednesday.

"They saved many lives and I have nothing but congratulations for their entire workforce and their volunteers," Binder said. "This had to be an all-out effort."

But Holland said he and his staff aren't stopping now. "We've done some great work, but we have to keep going."

Contact Karen Weintraub at kweintraub@usatoday.com.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

This article originally appeared on USA TODAY: Are hospitals getting safer? New report from Leapfrog Group released.