Introduction to Patient Safety
1. Patient safety is all about how hospitals and other healthcare organizations protect their patients and families from infections, accidents, injuries adverse effects and errors related to health care delivery. Patient safety is a serious health concern in all medical facilities (WHO, 2017). There is a chance that one person in a million may get harm when traveling by airplane, but one out of every 300 people get harm when in the hospital(WHO, 2017). Although many healthcare organizations are good at keeping their patients safe, some hospital has failed. According to the World Health Organization (WHO) 2018, 18,000 patients die every year due to medical errors in Australia. In addition to that, about 50,000 patients get disabled due to factors related to patient safety. In the United States of America (USA) medical errors resulted in as many as 98,000 deaths each and every year. Other statistics by WHO 2018 report shows that, patients safety deaths are the fourteenth leading deaths in in health care sectors across the globe accounting for about 43 million deaths every year of which 42 million of this are due to medication errors.
There are various reasons that may hinder patients’ safety in our hospitals. First, the health care systems have become more complicated in the past few decades due to an increase in the use of new technology, dynamic treatment methods, and procedures plus the rice of new medicines (Mcfadden, Stock, & Gowen 111, 2015). Other than that, the hospital usually receives different kind of patients of which some may be aged or present with complicated conditions (McFadden, Stock, & Gowen 111, 2015). Health care professionals may have difficulties when making decisions for such patients which in turn can lead to medical errors. In addition, due to unequal distribution of health workforce affected by social-economic determinants of health canlead to health workers having a work overload (Mcfadden, Stock, & Gowen 111, 2015). Safety in health care is broader than patient safety. It includes the safety of all health care providers including doctors and nurses. Due to these facts the WHO have developed four major strategies that may help to minimize errors made during health care in order to promote patient safety and safety in health care. These include providing a comprehensive leadership strategy that promotes cooperation of healthcare workers, establishing and developing tools and guidelines that enhance healthcare workers building capacities, monitoring patients safety improvements and engaging clients and their families for safer caring(WHO, 2018).
Due to the problems associated with patients safety, hospitals often apply risk management and analysis strategies to address them (Mcfadden, Stock, & Gowen 111, 2015). There are various dimensions that are involved in risk management. These include the organizational resources, structure, procedures, and processes needed to plan, analyze, evaluate and treat patients risks so as to provide better patients safety (Mcfadden, Stock, & Gowen 111, 2015). Risk management in a clinical setting is normally a process that involves various steps of risk assessment, judgment and taking the correct actions for risk treatment. (Arfanis, & Smith, 2012). Health care settings are complex and they involve interactions with clinical procedures, diseases processes, hospital resources including both human and manmade, technologies and policies (Arfanis, & Smith, 2012). The interactions of those factors can lead to unanticipated outcomes and harms to patients. Due to those facts a health risk management is needed.
Reasons for Hinder Patient Safety in Hospitals
There are various steps that are involved in health risk management. These includes risks context establishment, identification of available risks, risk analysis, evaluation, and risks treatment. (Guo, 2015).After risk identification and assessment, a risk analysis is a crucial part of risk management. This is due to the fact that, risk analysis enables healthcare workers to distinguish minimum acceptable risks from unacceptable complicated ones (Guo, 2015). In order to do this, healthcare professionals normally uses various risk analysis tools. These include The These include the Consequences Assessment Indicative Table, Risk Ranking and Criteria Table, Control Adequacy Assessment Table and the Likelihood Table. Below is an example of a Consequences assessment table that can be used to analyse the severity of risks in a hospital
|
Severity levels |
Consequences categories |
|
1 |
Insignificant |
|
2 |
Minor |
|
3 |
Moderate |
|
4 |
Major |
|
5 |
Catastrophic |
2. Safety culture refers to an organizational culture that can affect the behaviors and attitudes of its members as related to safety and health of the institution. This includes healthcare workers and group values, behaviors perttens, attitudes, perceptions and competencies might influence health care professionals commitments towords organization health and patients safety (Lozito, Whiteman, Swanson-Bierman, B., Barhymer, & Stephens, 2018). Evidence has shown that the culture of an organisation can affects the way health care workers respond to adverse effects or errors experienced. (Azizi, Siddiqui, & Iqbal, 2017). In order to promote positive cultures in a hospital, strong commitments in terms of management and leadership are needed. Leaders and managers need to demonstrate to others by acting as a good example of how things need to be done (Nacioglu, 2016). The key management roles is to demonstrate commitments and act accordingly in order to influence the attitudes and behaviours of other health care professionals Safety culture is influenced by various safety culture domains which include supervisions, safety systems, management jobs satisfaction, management perceptions, risks available, working conditions, commitments of the organization in policy implementation and the overall values and beliefs of workers(Halligan, & Zecevic, (2011).
The key factors that can lead to poor safety culture in any given health organization are poor management and leadership qualities (Mcfadden., Stock, & Gowen 111,2015). Managers and supervisers who do not portray good leadership skills in hospitals end up promoting poor safety culture. (Daly, Jackson, Mannix, Davidson, & Hutchinson, 2014). A health organization can measure its safety culture in different ways. First is by identifying the level of commitment its workers have (McSherry, & Pearce, 2016). Commented workers respond quickly to an emergency, treat patients with respect and dignity and are always aware of all standard procedures in the hospital. Secondly, safety culture can be measured by evaluating the outcomes (Halligan, & Zecevic, 2011). Positive outcomes indicate all health workers are collaborating in health care delivery and understand how the organization system works (Mcfadden., Stock, & Gowen 111,2015). On the other hand, Poor safety culture always affects patients’ care and health workers in various ways. These include poor patients support, staffs intimidations, late responses to adverse effects thus increasing patients disabilities and poor continuous education for healthcare workers.
3. The ten National Safety and Quality Health Services Standards (NSQHS) were developed by the Australian Commission for Safety and Quality Health Care (ACSQHC) in the year 2012 for the purpose of protecting individuals and their families from health services related harms. The standards were developed to enable health service organizations to deliver quality and safe care (ACSQHC, 2012). All standards were consistent with the current evidence-based practice and were indented to enhance deliverance of best outcomes across the country. The first two standards were established to promote the effective use of the other eight standards. These include Governance for Safety and Quality in Health Service Organization and Partnering with Consumers (ACSQHC, 2012). The first standard was developed to guide healthcare organizations in adopting a plan, policy or program that provides information about individuals, caregivers and the community (ACSQHC, 2012). The organizations were then supposed to actively involve the consumers by presenting their plan to them in order to understand their decisions or proposed plans (ACSQHC, 2012). The standards have been reduced from ten to eight in number in the second edition developed in 2017. Although the second edition has eight standards, the concepts are similar to the original version (Safety and Quality, 2018). However, the second versions highlight the improvement that has been made and gaps that still to be implemented which will later be evaluated in the year 2019 (ACSQHC, 2017). Both editions must be approved and accredited by Ministry of Health, International Society for Quality in Health Care and the Joint Accreditation Scheme of Australia for quality and legal purposes (Safety and Quality, 2018).
The Importance of Risk Management in Patient Safety
Through the use of Standards, health care institutions have been able to set responsibilities and relationships between the available workforce, executive and other stakeholders including patients and their families (ACSQHC, 2017). This includes incorporating a set of customs, laws, processes, and conventions that guides hor hospitals are administered and directed. Over the time, health care organizations have been able to provide a specific structure by using objectives that are achievable (Safety and Quality, 2018). The standards have also increased individuals health literacy (Australian Commission on Safety and Quality in Health Care, 2013). This is due to the fact there has been an elaborate process of how people can obtain and understand useful health care information concerning various treatment methods, health system and other health-related concerns (Safety and Quality, 2018). This, in turn, has enabled patients seeking healthcare to be able to make decisions concerning their health care. In addition, the standards have promoted an effective care that is based on a partnership with consumers. Patients have benefited from high-quality care and good hospital experiences that recognise their dignity and respect (ACSQHC, 2017). More services that are appropriate and accessible for consumers have been established due to the current involvement of individuals and communities in health services planning, monitoring and evaluation (ACSQHC, 2017). For instance, there has been evidence of improved clinical outcomes with minimal readmissions, the nosocomial infections have drastically decreased, there has been an increase in health promotion and preventive strategies, improved adherence to treatments and increased health workforce.
References
Allen, S., Chiarella, M., & Homer, C. S. E. (2010). Lessons learned from measuring safety culture: An Australian case study. Midwifery, 26, 497–503. doi:10.1016/j.midw.2010.07.002
Arfanis, K., & Smith, A. (2012). Informal risk assessment strategies in health care staff: An unrecognized source of resilience? Journal of Evaluation in Clinical Practice, 18, 1140- 1146. doi:10.1111/j.1365-2753.2011.01759.x
Australian Commission on Safety and Quality in Health Care (ACSQHC). (2012). The national safety and quality health service standards. Sydney: ACSQHC. Retrieved from https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf
Australian Commission on Safety and Quality in Health Care. (2013). The National Safety and
Quality Health Service Standards in 2013: Transforming the safety and quality of health care. Sydney: ACSQHC. Retrieved from https://www.safetyandquality.gov.au/wp-content/uploads/2014/10/NSQHSS-in-2013-Transforming-the-safety-and-quality-of-health-care.pdf
Australian Commission on Safety and Quality in Health Care (ACSQHC). (2017). National Safety and Quality Health Service Standards Second edition. Retrieved from https://www.safetyandquality.gov.au/wp-content/uploads/2017/12/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf
Azizi, S., Siddiqui, F., & Iqbal, I. (2017). Changing health care culture: A prerequisite to improving patient safety. Therapeutics and Clinical Risk Management, 13, 623–624.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5428755/doi: 10.2147/TCRM.S138896
Daly, J., Jackson, D., Mannix, J., Davidson, P.M., & Hutchinson, M. (2014). The importance of clinical leadership in the hospital setting. Journal of Healthcare Leadership, 6, 75-83. https://epubs.scu.edu.au/cgi/viewcontent.cgi?article=2954&context=hahs_pubs
Halligan, M., & Zecevic, A. (2011). Safety culture in healthcare: A review of concepts, dimensions, measures, and progress. BMJ Quality and Safety, 20, 338-343. doi:10.1136/bmjqs.2010.0409
Li, Guo. (2015). Implementation of a risk management plan in a hospital operating room. International Journal of Nursing Sciences, 2(34), 348-354. Retrieved from https://www.elsevier.com/journals/internationaljournal-of-nursing-sciences/2352-0132
Lozito, M., Whiteman, K., Swanson-Bierman, B., Barhymer, M., & Stephens, K. (2018). Good catch campaign: Improving perioperative culture of safety. Quality Improvement, 10(6)705-714. Retrieved from https://doi.org/10.1002/aorn.12148
Mcfadden,K. L., Stock, G. N., & Gowen 111, C. R. (2015). Leadership, safety climate, and continuous quality improvement: Impact on process quality and patient safety. HealthCareManagement Review, 40(1), 2434.https://doi.org/10.1097/HMR.0000000000000006
McSherry, R., & Pearce, P. (2016). What are the effective ways to translate clinical leadership into healthcare quality improvement? Journal of Healthcare Leadership. 8, 11-17.doi: 10.2147/JHL.S46170
Nacioglu, A. (2016). As a critical behavior to improve quality and patient safety in healthcare: Speaking p! Safety in Health, 2(10), 1-25. Retrieved from https://doi.org/10.1186/s40886-016-0021-x
Safety and Quality. (2018). Accreditation and the NSQHS Standards. Retrieved from https://www.safetyandquality.gov.au/our-work/assessment-to-the-nsqhs-standards/
World Health Organization (WHO), (2018). 10 facts on patient safety. Retrieved from https://www.who.int/features/factfiles/patient_safety/en/
World Health Organization (WHO) (2017) Patient Safety Making health care safer. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/255507/WHO-HIS-SDS-2017.11-eng.pdf;jsessionid=C4B5BBC298C208D9774B59BE330D3115?sequence=1
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