Improving Health Care Delivery for Underserved Patients: Q&A with Jerard Kneifati-Hayek

Biomedical research is a driving force behind medical progress, “but it’s not the only way to improve clinical practice,” says Jerard Kneifati-Hayek, an internist at Columbia who sees firsthand how medical advances affect his patients.

“We also need to examine how we currently deliver care and how we can make it better and safer."

Kneifati-Hayek's drive to improve the health of patients by focusing on health care processes led him to Columbia, where in 2018 he became the first Patient Safety Research Fellow at the Center for Patient Safety Science. The two-year fellowship, he says, taught him how to address real-world safety and quality issues in clinical care and how to design and test solutions that can be scaled up and applied across health care systems.

Kneifati-Hayek recently received a KL2 Mentored Career Development Award to continue his patient safety and quality research and was one of “40 Under 40” medical professionals honored by the National Hispanic Medical Association and National Hispanic Health Foundation for their “unwavering dedication to their craft and their communities.”

We spoke to Kneifati-Hayek, now assistant professor of medicine, about his latest efforts to improve patient safety and health care quality, particularly for those from underserved communities.

Why has patient safety and quality research drawn your interest?

Medical errors are one of the leading causes of death in the United States. It’s a serious issue that is often overlooked. After seeing various types of medical errors throughout my training, I was drawn to patient safety research.

My work focuses on leveraging health information technology to identify and measure errors, then come up with innovative solutions to prevent them. There’s a lot of gratification that comes from developing system-wide solutions to improve health care. As a hospitalist, I am on the front lines of the health care system, and it allows me to see system issues and think of ways to fix them.

Can you tell us about a couple of your recent safety and quality projects?

We know that patients with limited proficiency in English experience higher-than-average rates of adverse events in hospitals. This is largely attributable to errors in communication, but despite federal mandates, interpreters are underused across health care.

In 2022, I started a study that identified barriers to the use of interpreters and then devised and tested possible ways to encourage their use. In just two months, we increased the median use of interpreters in patient encounters from 10% to 25% in a medical-surgical unit.

More recently, with the support of a Clinical Trialist Early Career Development Scholars Award, I’m studying incorrectly ordered imaging tests. This is a major cause of diagnostic errors, although we know very little about why it happens.

To learn more, we’re adapting and expanding on the automated Retract-and-Reorder method developed by Jason Adelman [associate dean for quality and patient safety at VP&S], which he has used to identify near-miss medication errors and test ways to make electronic ordering safer. Near misses—orders that are retracted and then corrected—are far more common than voluntarily reported errors, so this gives us much more data for studying how mistakes are made and devising solutions to improve patient safety.

Changing the subject a little: You’re a founding member of the board of directors of the VP&S Latino Association. Why is this work important to you?

It starts with my mother, who is from Peru. She raised me as a single mom in Brooklyn yet still managed to return to school to become an ICU nurse. That inspired me to go into medicine. Otherwise, I had no other role models. I don’t remember seeing any Latino doctors when I was growing up, and when I got to Columbia, there were few other faculty who looked like me.

Roughly 19% of the population in the United States is Latino, but only 6% of doctors are Latino. The percentage is even lower in academic medicine. This matters: Research shows that outcomes are better when patients have providers who speak their language or have similar backgrounds.

The Latino Association is a way for me to give back by bringing more Latinos into the health professions and engaging with the Latino community at large.