The Media’s Role in Patient Safety
Brief History of the Media Influencing Patient Safety
Despite studies raising questions about avoidable harm that began appearing in the medical literature starting in the mid-1950s, the profession’s lack of acknowledgment regarding the implications for patient safety resulted in those studies having little to no impact on care.1 The impetus for change was reporting by the news media that made it clear that improvements in patient safety were urgently needed.2 The catalyst was a March, 1995 Boston Globe story about Betsy Lehman, a young mother and Globe medical columnist who died when a fatal dose of cyclophosphamide was accidentally administered during her treatment at a prestigious Harvard-affiliated hospital.3 That story, in turn, helped prompt publication of other news stories detailing patient safety problems nationwide. In response, professional organizations such as the American Medical Association began to acknowledge that a systemic response to reduce error was needed. These developments set the stage for the Institute of Medicine (IOM) report, To Err is Human: Building a Safer Health System, released in late 1999.4
The IOM report attracted media attention to a national strategy for improving patient safety by including a sobering statistic: 44,000 to 98,000 Americans died every year from preventable medical error in hospitals. Crucially, those large numbers were made real by relating the stories of three actual patients who were the victims of adverse patient safety events, drawing on news media accounts that had provided names and details. A later survey found that a significant segment (51%) of the US public had become aware of the report.5 The media’s coverage also stimulated changes ranging from enactment of state laws requiring mandatory reporting to changes in Medicare rules to a patient-safety improvement appropriation of $50 million to the Agency for Healthcare Research and Quality (AHRQ), which was designated as the federal lead in patient safety. Since the IOM report, many efforts have been made to improve patient safety including, but not limited to, enactment of the Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act) and the Partnership for Patients, a joint public-private effort to reduce Hospital Acquired Conditions by 40 percent.6
In the more than two decades since the IOM report was released there have been significant changes in news media reporting. Traditional media (e.g., newspapers, television and radio) is under intense pressure to produce attention-grabbing material and to do so with less space and/or in a smaller amount of time. Data-driven reports related to patient safety may be perceived as less interesting because they lack a human-interest element and are more often covered by non-traditional media sources.7 Even when there is a human-interest component, patient safety issues might only be picked up and reported secondarily through traditional media sources, given the movement in media consumption by the public toward favoring “clickbait” stories that are easy to read. The rise of social media, which is particularly amenable to that approach, leads to the question of its role in this area.
Social Media Applied to Healthcare Settings
The term social media generally refers to Internet-based tools that allow individuals and communities to communicate in order to share information, ideas, personal messages, images, and other content and, in some cases, to collaborate. Social media platforms such as Facebook, Twitter, and Yelp have become increasingly common vehicles for transmitting information and have potential for effecting change. Because social media has the capacity to be an effective conduit for highlighting patient safety issues, as the Boston Globe did more than two decades ago, this Perspective looks at examples beyond the obvious extension of traditional media (e.g., a newspaper’s Facebook page or Twitter postings) of social media used in a patient safety or other healthcare setting.
For instance, a survey of stakeholders in Australian hospitals found that Facebook was the predominant form of social media used to collect consumer feedback regarding quality improvement and service design. (Engagement of consumers is a requirement for public hospital accreditation in Australia.) While Facebook use predominated, other forms of social media used to a lesser extent included YouTube, Instagram, LinkedIn, Pinterest, and Twitter.8 In other research, a large dataset of Facebook reviews was studied to identify service attributes of hospitals that consumers discussed online including treatment effectiveness, diagnostic quality, environmental sanitation, and cost considerations.9 Nakhasi et al explored the use of Twitter to assess patient perspective on perceived medical errors and concluded that it may be a means to identify and communicate with patients who have experienced an adverse patient safety event.10 A study of large acute care teaching hospitals in the United States compared hospital star ratings from Facebook, Google, and Yelp, with patient satisfaction surveys and postsurgical patient safety indicators.11 Among the social media platforms, Yelp was most strongly correlated with the patient satisfaction surveys while Google was modestly correlated and Facebook least strongly correlated. None of the social media platform ratings correlated with surgical safety indicators.
Reporting adverse drug reactions (ADRs) through Twitter is another example of social media use in regard to safety. Lardon et al reported that, among a population of tweets, a subset of messages could be identified as potentially serious ADRs and that Twitter could become a complementary source of information for pharmacovigilance.12 Patient safety educational campaigns centered around social media have also been reported but this communication was amongst healthcare providers and not the public. Henderson et al reported that predominantly Facebook, but also YouTube, Twitter, and blogging, were social media sources that were used effectively to further engagement and communication amongst healthcare providers to disseminate awareness of the World Health Organization’s Surgical Safety Checklist.13
Despite many examples in the literature of social media being applied to healthcare settings, there were no clear examples where provider actions were directly influenced in regard to patient safety. However, this type of media holds potential as an easily accessible form of communication that, in theory, could be utilized effectively for disseminating information or for data mining.
Potential Future Role of Traditional and Social Media in Patient Safety
Traditional media helped turn patient safety into a national priority and highlighted the need for the policy community and health care professionals to respond. In the 27 years since the death of Betsy Lehman became front page news, the media and the profession have undergone profound change. While general interest news organizations have declined, specialized online healthcare news services have emerged whose investigations of patient safety can spread widely via the web. Meanwhile, social media platforms have emerged that lack the “gatekeepers” that are present in traditional media. This allows information to spread more quickly, but potentially at the expense of accuracy. Novel methods of transmitting information through social media for the purpose of improving patient safety have yet to be fully explored.
Michael L. Millenson
President, Health Quality Advisors LLC
Adjunct Associate Professor of Medicine at Northwestern University Feinberg School of Medicine
Paul Dowell, PharmD, PhD
American Institutes for Research
Sarah E. Mossburg, RN, PhD
American Institutes for Research
Crystal City, VA
1 Blumenthal D. Making medical errors into ‘medical treasures.’ JAMA 1994: 272:1867–8.
2 Millenson ML. Pushing the profession: how the news media turned patient safety into a priority. Qual Saf Health Care. 2002 Mar;11(1):57-63.
3 Knox RA. Doctor’s orders killed cancer patient. Boston Globe 23 March 1995, section 1, 1.
4 Institute of Medicine. To err is human: Building a safer health system. Washington, DC: National Academy Press, 1999.
5 Kaiser/Harvard Health News Index 1999;4 (available at http://www.kff.org/content/2000/1565/HNI%20Nov-Dec1999.pdf)
7 Olsen AL. Human Interest or Hard Numbers? Experiments on Citizens’ Selection, Exposure, and Recall of Performance Information. Public Administration Review 2017;77(3):408-20.
8 Walsh L, Hyett N, Howley J, Juniper N, Li C, MacLeod-Smith B, Rodier S, Hill S. Social Media as a Tool for Consumer Engagement in Hospital Quality Improvement and Service Design: Barriers and Enablers for Implementation. Int J Health Policy Manag. 2021 Nov 3. doi: 10.34172/ijhpm.2021.151. Epub ahead of print. PMID: 34814682.
9 Zaman N, Goldberg DM, Abrahams AS, Essig RA. Facebook hospital reviews: automated service quality detection and relationships with patient satisfaction. Decision Sciences 2020 Aug;52(6):1403-31.
10 Nakhasi A, Bell SG, Passarella RJ, Paul MJ, Dredze M, Pronovost PJ. The potential of Twitter as a data source for patient safety. J Pat Saf. 2019 Dec 1;15(4):e32-5.
11 Synan LT, Eid MA, Lamb CR, Wong SL. Crowd-sourced hospital ratings are correlated with patient satisfaction but not surgical safety. Surgery. 2021;170:764-68.
12 Lardon J, Bellet F, Aboukhamis R, Asfari H, Souvignet J, Jaulent MC, Beyens MN, Lillo-LeLouët A, Bousquet C. Evaluating Twitter as a complementary data source for pharmacovigilance. Expert Opin Drug Saf. 2018 Aug;17(8):763-774. doi: 10.1080/14740338.2018.1499724. Epub 2018 Jul 26. PMID: 29991282.
13 Henderson D, Carson-Stevens A, Bohnen J, Gutnik L, Hafiz S, Mills S. Check a box. Save a life: how student leadership is shaking up health care and driving a revolution in patient safety. J Pat Saf. 2010 Mar 1;6(1):43-7.