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    Developing standards for hospital-wide patient safety

    Jens Hooiveld
    Last modified: 18 May 2021

    The World Health Organization (WHO) issued a rallying cry about patient safety as a global public health concern—and with good reason. There’s a 1 in 300 chance of a patient experiencing harm in the healthcare setting, while by comparison, an airline passenger has a 1 in 1 million chance of being harmed. In addition to the risks of injury or death, failure to adequately address patient safety increases the cost of care.

    As a result, developing and implementing standards for patient safety is crucial to:

    • Establish acceptable levels of provider performance
    • Create consistency and uniformity of care across organizations
    • Set expectations for patients and other healthcare participants
    • Maintain strong financial performance to fund ongoing quality improvements

    Why take a uniform approach to safety?

    As your hospital or healthcare organization becomes a multi-faceted healthcare enterprise, you invite new risks and vulnerabilities. A strong, consistent, organization-wide framework for patient safety, paired with the right technology, can make all the difference in helping your organization prevent harm and preserve fiscal health.

    Developing and implementing a standards-based approach to patient safety starts with a strategy: Encourage the reporting of (near) incidents, use uniform terminology for documenting and analyzing them, and benchmark the results to learn from them. Equally important: ensuring alignment across all sites of care—the hospital setting, clinics, pharmacy, and more—and embracing a digital approach to report incidents, instead of relying on paper and manual processes.

    >> Learn more about patient safety with our Roadmap to improve patient safety.

    Regulators guide on “what”, but not “how”

    Of course, laws, regulations, and accreditation standards (e.g., from Joint Commission International) provide a foundation for creating hospital safety standards. However, in many cases, the regulations guide healthcare organizations on what benchmarks or outcomes they must achieve—but they do not mandate the methods or practices they must use to comply.

    So how can your healthcare organization find an approach that will work for your unique challenges today and in the future? Start with self-assessment and conduct research about various standards and methodologies for improving patient safety.

    Possible standards to increase patient safety

    The following are standardized approaches to patient safety for consideration in your hospital or healthcare organization:

    1. Standards for reporting incidents
    2. Standards for sharing learnings
    3. Adopting a uniform terminology
    4. Standards for analyzing events
    5. Aligning departments and facilities
    6. Automating quality and risk processes

    1. Standards for reporting incidents

    Incident reporting is the act of documenting all incidents and near incidents, ideally using an online form and workflow to capture details and share the account digitally. (Near) Incidents are also reported through complaints, audits, and safety rounds.

    The U.S. Agency for Healthcare Research and Quality points to four characteristics of successful incident reporting systems for patient safety. These include:

    1. Creating a supportive, privacy-protected environment where staff members report adverse events
    2. Encouraging a broad range of healthcare team members to submit such reports
    3. Requiring a timely approach to communicating about incidents
    4. Building and adhering to a structured mechanism for reviewing reports and developing action plans

    To this end, many healthcare organizations have embraced the Just Culture approach, which encourages openness—yet allows anonymity—to encourage incident reporting and to drive accountability for both individuals and the healthcare organization at large.

    2. Standards for sharing learnings

    A study of 30 adverse events in cardiovascular surgery pinpointed system design problems, rather than negligence or incompetence by individual clinicians. The researchers’ conclusion? Embracing a systems-theoretic accident analysis technique—rather than assigning blame to individual clinicians or technicians—helps to better understand the root causes of adverse events. However, mere discovery of adverse events, without sharing those learnings among key stakeholders, is unlikely to drive quality improvements.

    Learning from incidents is crucial toward the goals of achieving greater patient safety and higher-quality care. Initiatives like Safety II were created to encourage transparency and to “learn from what goes well.” But creating a basic willingness among staff to be open and upfront also requires a structured approach that values and makes the reporting exercises worthwhile by executing on the data and findings.

    Representing a new way of thinking, Safety-II starts by looking at daily practices—not at the design of the guidelines, processes, and protocols. This analytical method originally stems from the technical sector, and was first used in aviation and construction before it was adopted for use in healthcare. Safety-II also informs us that we cannot manage safety and improvements if we don’t know the specifics of how things work in practice.

    3. Adopting a uniform terminology

    Understanding medical terminology, the “language of medicine,” allows clinicians and staff to communicate effectively for maximum safety. For healthcare providers, it starts with their initial education and training and never stops—as they must keep up to date with new regulations and medical advancements once on the job.

    In 2004, the WHO organized the WHO Patient Safety Program and the International Classification for Patient Safety. And in 2009, Sir Liam Donaldson, MD, patient safety envoy at the WHO, argued for a uniform approach to terminology around patient safety. As a result, there is growing acceptance regarding terminology for incidents and events. For example:

    • The Canadian Patient Safety Institute uses “patient safety incident” in its Canadian Incident Analysis Framework to describe adverse events impacting patient care.
    • The NSW Government in Australia, which also uses this terminology, describes a patient safety incident as an unplanned event that could have, or did, result in patient harm.
    • The U.S. Institute of Medicine created a glossary of terms related to patient safety. It defines terms such as an adverse event, a close call, adverse event triggers, and Iatrogenic injury (or an event originating with a physician).

    4. Standards for analyzing events

    The ability to report incidents internally and externally and to create action plans for improvement requires the use of standard analytical methods. Patient safety, quality improvement, and risk management professionals have numerous methods to analyze incidents through a variety of retrospective and prospective methods.

    Examples of such methods include:

    1. SIRE method: Appropriate for incidents with serious consequences or those that occur frequently, it includes the following: timeline analysis, process analysis, and barrier analysis.
    2. Ishikawa method: This diagram-based tool helps draw a cause-and-effect relationship.
    3. PRISMA analysis: This root-cause analysis method uses a “cause tree” to map incidents schematically; this enables easy understanding of underlying factors and circumstances.
    4. FMEA analysis: A systematic and proactive analysis of healthcare processes, it helps identify potential failure modes and their causes and effects.
    5. FRAM analysis: This process visualization tool illustrates the difference between procedure and daily practice.
    >> Learn more about analyzing incidents, check our special topic page "How to analyze incidents in healthcare".

    5. Aligning departments and facilities

    Ensuring alignment across today’s multi-faceted healthcare organizations is challenging. To address this, U.S. patient satisfaction survey company Press Ganey advises patient safety leaders to note the interdependencies across the departments/functions responsible for clinical quality, patient safety, workforce engagement, and the patient experience.

    To ensure alignment around patient safety, all team members must take responsibility for quality improvement. In addition, quality, risk, and patient safety professionals must assess the organization's safety culture, understand the relationship between organizational objectives and patient safety, and help the facility learn structurally from incidents.

    6. Automating quality and risk processes

    Using a digital quality management system—one that includes an improvement-tracking system that supports the management of improvement projects—has a powerful impact on patient safety. This approach can be initiated as a result of a specific adverse event, a trend, or a specific issue.

    Quality, risk, and patient safety leaders can design workflows within the digital system to create tasks, actions, and lead times to ensure the implementation of quality improvement initiatives.

    In addition, a digital approach should facilitate the sharing of incidents anonymously. Healthcare facilities can display dashboards illustrating patient safety measures in staff break rooms or cafes to educate staff members. Overall, a paperless approach to patient safety increases standardization while supporting a Just Culture where the goal is to learn from mistakes.

    The Patient Safety Company

    Worldwide we are assisting over 500 organizations with their quality and risk management. As a result, they have improved their safety and quality, by increased control over incidents and the possibility to analyze and report on them.

    Are you interested in implementing a standards-based approach to patient safety too? Contact our Sales team to discuss your options.

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