Healthcare Threat Safety Science

Dr. Denham has spent many years leading initiatives in the arena of unintentional harm to patients and caregivers from healthcare accidents and systems failures.  He and his colleagues have now expanded their successful work to take an “all cause harm” approach to understanding the specific and relative harm from both inside and outside threats to healthcare institutions. The threats, vulnerability, risk, and harm to those who serve – the clinical and non-clinical staff AND those who are served – the patients and their families who receive care. This led them to pioneer a new domain called Healthcare Threat Safety Science and to begin to classify the threats using the Healthcare Threat Safety Spectrum depicted below. Click here to download Healthcare Threat Safety Science: The Future, a white paper research report written by Dr. Denham, Dr. Botz, V. King, and Chief Adcox of the MD Anderson Cancer Center.

The healthcare threat spectrum is expanding rapidly with new visible and invisible threats appearing almost daily.  Realizing a reconciling classification of threats, risk, and harm is sorely needed at the governance level of institutions, HCC and TMIT has set out with world-class leaders in the field to develop an International Healthcare Classification for Threat, Risk, and Harm. It will stand on the shoulders of other classifications and staging systems already used in oncology, risk management, and aviation. This will assist all stakeholders by helping them understand how to reduce preventable harm to healthcare professionals including caregivers and researchers, consumers and their families, and healthcare institutions.  It will address the full continuum of threats from unintentional accidents to intentional malfeasance of individual actors and nation state medical espionage.  It will be published as a working model in fall of 2018.

The 4 P’s: Prevention, Preparedness, Protection, and Performance Improvement

Our global team of experts are taking a systematic approach to the threat spectrum facing healthcare. The concept of “left of boom” is a term used by the military when they try to move up stream to prevent an event from happening or reducing the harm if it does. The rapid evolution and intensity of visible and invisible threats healthcare is now experiencing demands that we be nimble and move Left of Boom.  Our strategy can be described as “The 4 P’s”.  We must move beyond Protection at the time of an event, and move upstream not only to Preparedness, but to Prevention. Prevention includes both primary prevention to make sure certain things never happen, AND secondary prevention– making sure damage is minimized, the disruption is shortened, and the recovery is most complete. Lastly, the discipline of Performance Improvement pioneered in patient safety and aviation can be applied as a feedback loop to get better by learning from adverse events.

Med Tac Global

While working at the Texas Medical Center with the MD Anderson Cancer Center leadership team on all-cause threat strategies for hospitals described above, the team began dealing with the daunting task of preventing harm during active shooter events. A global team was assembled, and an integrated program was developed to tackle improving bystander care of the 8 leading preventable causes of death of otherwise healthy children, youth, and adults in their workforce years. Pilot programs are underway in California, Texas, Florida, and very soon in Hawaii.  Click here for more detail presented on this website.

Professional Identity and Medical Identity Harm

An exploding global crisis of trust in government, business, media, and non-governmental organizations is raising great concerns around the world. Healthcare is experiencing such a trust crisis. The internet has generated enormous positive opportunities in all sectors, however the law of unintended consequences is in full force.  The web and the misuse of media has generated an enormous array of new threats to professional caregivers, administrators, and governance leaders as well as patients and their families. Click here to download Healthcare Cybercrime and Harm Classification 2017, a summary of definitions published by TMIT with security and medical leaders at MD Anderson Cancer Center.

The Professional Identity of a caregiver or non-clinical healthcare professional includes the documentation of their education, credentials, and behaviors. It may be in semi-private documentation such as human resources reports used by organizations for advancement, tenure, compensation, or in some cases used improperly to protect the financial assets of an organization after an adverse event.  It also includes the reputational identity defined in the media by the press or anyone on the internet that if communicated improperly may be defamatory and cause harm to individuals. Dr. Denham has championed the cause for justice for professional caregivers in both publications and broadcast film prior to having his own direct experience with fraud, false claims, and defamation by unscrupulous journalists and academic competitors damaging his professional identity.  This further ignited his passion for launching The Healthcare Innocence Project described below.

Everyone has a Medical Identity defined by the aggregate medical record documentation regarding their health. Again, the internet has had both positive and negative impact on patients and their families. The development of digital healthcare records has given rise to breach, theft, contamination, and the need for remediation of records. In fact, it is estimated that more than one third of the medical records of Americans will be breached in 2018, one fifth of those will be contaminated, and one third of that group will lose their healthcare insurance due to unresolved contamination.

Dr. Denham and an international R&D team are developing innovative solutions to tackle these problems. They couple continuing education through CareUniversity that reduces risk with tailored insurance solutions that pay for specific legal remediation services if an incident of identity harm occurs. These solutions for both professional and medical identity harm prevention and remediation incorporate Information technologies such as predictive risk analytics algorithms and blockchain innovations.

The Healthcare Innocence Project

An early pilot program of TMIT currently being explored is the development of The Healthcare Innocence Project.  It builds on the successful model of The Innocence Project founded by attorneys Peter Neufeld and Barry Scheck.  Neufeld and Scheck used the new technology of DNA 25 years ago to exonerate those who were wrongly convicted of certain crimes. Our new technology is the “digital DNA” of electronic records in the Electronic Health Record (E.H.R.) and digital administrative records that can be used to defend and protect the medical identity of patients and the professional identity of caregivers.  Both patients and caregivers may be unjustly treated through intentional or unintentional behaviors of insiders or outsiders of healthcare organizations. For caregivers and healthcare staff, this includes weaponization of the Human Resources records of their employer, sham peer review, release of false records to the press, and false allegations of conflict of interest, workplace violence, or harassment. Patients and families are very frequently unjustly treated during malpractice litigation after healthcare accidents when defense teams try to discredit them as a routine negotiation ploy or to win a jury verdict. They are frequently harmed from outsider cybersecurity breaches that lead to their healthcare insurance being fraudulently charged for services or drugs. This leads to medical identity and record contamination and costly remediation or even loss of insurance coverage.  Dr. Denham is working with experts in the domains of healthcare law and media law to address these issues. One such effort is through publication of Red Cover Reports which implement the NTSB investigative approach to case studies. Click here to learn more about Red Cover Reports by downloading the article An NTSB for Health Care – Learning From Innovation: Debate and Innovate or Capitulate written by Dr. Denham, Captain Sully Sullenberger, Dennis Quaid, and the attorney, John Nance JD who developed the Red Cover Report concept.