What is meant by the term ’patient safety’?
1. What is meant by the term ’patient safety’? Differentiate between safety in health care and patient safety. In the context of patient safety, what is understood by the term risk management and what is its aim? Briefly discuss the approaches and/or tools that a health professional is likely to use when completing a risk analysis.
Patient safety is the concept in healthcare where the focus is on the proactive reduction, prevention, analysis, and reporting of errors and various potential harms that might adversely affect patients’ health (Simsekler et al., 2020). The concept emerged with the evolution of healthcare systems that are becoming more complex leading to an increased possibility of patient harm. One major aspect of patient safety practice is that it facilitates continuous improvement in the healthcare system owing to the lessons learned from the adverse events and errors. The discipline of patient safety aligns with the Values Of Healthcare Services throughout the world. These values include safe, effective, and person-centred care. For successfully implementing strategies for patient safety, it is important to develop clear policies regarding the same, ensure proper leadership, have a skilled healthcare professional team, effectively involve patients in their own care, and have data to drive improvements in safety (World Health Organization, 2019).
The distinction between the concepts of safety in healthcare and patient safety is that while safety in healthcare is just concerned with preventing any harm, patient safety is a broader concept concerned with not only ensuring lack of harm but also efficient and purposeful care of patients delivered at the right time to the right person. Safety in healthcare is only focused on avoidance of adverse events and decreasing the likeliness of mistakes but patient safety is concerned with improving the overall care experience for the patients.
Risk management in the context of healthcare refers to the set of administrative and clinical processes, systems, and reporting arrangements with the purpose to detect, assess, mitigate, and preventing patient risks (McGowan et al., 2021). The purpose of risk assessment is to identify risks at an early stage and ensure that they are properly managed and controlled and their adverse effects are reduced to a minimum. For this, it is crucial to ensure that healthcare professionals are actively reporting errors. A culture of patient safety helps to deal effectively with organizational vulnerabilities by providing sustainable strategies for risk assessment and increasing risk awareness. Risk management in healthcare helps in the effective handling of issues such as patient delays, billing, quality and safety concerns, and job duplication.
Risk management in healthcare organizations can be done through the ERM (Enterprise risk management) approach that primarily involves 8 main domains including operational, patient and clinical safety, financial, strategic, infrastructural or environmental hazards, legal, technological, and human capital (figure 1). Risk management in healthcare should be preventive because it the risk involved in this setting is one of life and death and hence it should be ensured that all hazards and errors are taken care of before any adverse event occurs. Another risk management approach is by using the blunt end/sharp end evaluation of clinical errors which is helpful in pinpointing errors in care (Garfield & Franklin, 2016). The model is an inverted triangle with clinical error at the sharp end and organizational procedures, systems, policies, constraints, and resources at the blunt end (figure 2).
Differentiating safety in healthcare and patient safety
Figure 1
Source: (NEJM Catalyst, 2018)
Figure 2
Source: (Schoenly, 2022)
2. Explain what is meant by the term ’safety culture’ in health care and discuss how it can be measured? What is the significance of a poor safety culture for health care professionals and patients?
Organizational safety culture is one where the risk of adverse events is constantly minimized despite hazardous and complex work. For a healthcare organization to be reliable, it should maintain safety commitment at all levels that is frontline service providers, managers, and executives. This contributes to establishing a safety culture. The main components of a safety culture include (1) acknowledging that the activities of the organization are of high-risk nature and then consistently working towards achieving safe operations; (2) a positive environment where people can freely report near misses or errors without fear of punishment; (3) encouraging effective communication and collaboration between various disciplines and ranks for better patient safety solutions; and (4) committing organizational resources to properly address and resolve safety issues (AHRQ, 2019).
To improve the overall quality of healthcare and reduce errors, there must a culture of safety in a healthcare organization. Moreover, to develop a patient safety culture, frequent error or incident reporting, feedback on errors, and adequate exchange of patient information are crucial steps. Organizations must also consider the influence of burnout and shift work on the culture of patient safety and plan and manage these factors accordingly to make the safety culture better (Khoshakhlagh et al., 2019). The essential factors of a culture of safety include: (1) a shared belief that the risks involved in the healthcare responsibility are high; (2) the organization is committed to detecting and analyzing injuries and errors related to patients; and (3) an environment where there is a balance between error reporting and responding disciplinary action (Khater et al., 2014).
To measure safety culture, one can use surveys with questionnaires designed to ask healthcare professionals to rank the safety culture both in their individual units and in the entire organization. These surveys can be used to find out whether doctors and nurses feel that they can report errors without any fear and whether they feel that management and the board are committed to solving those errors or not. These surveys are helpful for measuring safety culture in healthcare organizations because it duly gives value to the perspectives and experiences of the organization’s staff. The non-clinical and clinical staff directly observe the various aspects of the organization’s work and have the potential to identify the good and bad parts more accurately. Besides surveys, other methods include qualitative measurements such as interviews and focus groups, and ethnographic investigations. Regardless of the measurement approach, the crucial part to ensure is that the information and feedback collected from workers at multiple levels are used to implement actions for improvement. An example of tools available for measurement is the Australian Hospital Survey on Patient Safety Culture Version 2 (ACSQHC, 2022).
Poor safety culture involves poor communication and teamwork and a culture where there are low expectations of both the patients and the healthcare providers from the organization. The significance for providers is that they will not be able to report errors proactively and would also not be able to collaborate for patient safety. The significance for patients is that they might face issues such as delayed care, they will lose trust in the healthcare services, and might face poor health outcomes.
The concept and purpose of risk management in healthcare
3. Does clinical governance differ from clinical leadership in the context of quality and safety in health care provision? In your discussion include an overview of how professional communication between health professionals can enhance or impair the safety and wellbeing of patients.
No, clinical governance does not differ from clinical leadership. The purpose of clinical governance is to ensure that patients receive high-quality and safe care. Clinical leaders too have the primary responsibility to continuously improve the quality and safety of their services and ensure that the care is effective, safe, and patient-centered. The clinical governance standard accepts the worth of leadership, governance, safety of patients, clinical performance, and high quality patient care.
Clinical governance provides a framework that provides leadership for safety culture and quality improvement and ensures that patients, consumers, and carers work in partnership. It sets priorities and provides strategies for high-quality clinical care and ensures that these priorities and strategies are effectively communicated to both the community and the workforce. The management, workforce, clinicians, and the governing body all have specific roles and responsibilities. The framework also monitors the actions taken in response to any clinical incidents. The governing body makes sure that the organization’s standards of quality and safety duly address the special health needs of Torres Islander people and Aboriginals (Australian Commission on Safety and Quality in Health Care, 2019).
Collaboration in the context of healthcare refers to the practice in which various healthcare workers assume the roles of working in collaboration as a team and sharing responsibility for decision-making and problem-solving in order to form and implement patient care plans. This collaboration between nurses, physicians, and other members of healthcare enhances the awareness of team members towards the skills and knowledge of each other’s professions. This leads to better decision-making and continuous improvement. Additionally, the participation of patients is also crucial in delivering better health outcomes (O’Daniel & Rosenstein, 2018).
In the present system of healthcare, the care delivery involves multiple interfaces and handoffs of patients among healthcare professionals from different disciplines with varying occupational training and educational levels. During his hospital stay, a patient might interact with tons of different healthcare professionals including nurses, physicians, GPs, and others. Hence, for effective clinical practice, critical information regarding the patient (his history, medical diagnosis, vital signs) must be communicated accurately. Collaboration of a healthcare team involved with the treatment of a patient is necessary. If the healthcare system fails to communicate well, it is putting the safety of patients at risk. This is because an absence of critical patient information, misinterpretation of this information, unclear and vague instructions over the phone, and neglected or overlooked status changes can all lead to poor patient outcomes. When a patient has multiple health conditions, it becomes important to manage them all; however, it requires the collaboration of different healthcare professionals who can all utilize their unique healthcare expertise to deliver the best care outcomes. Lack of proper communication can lead to medication errors that will be detrimental to patients’ health (O’Daniel & Rosenstein, 2018).
References
ACSQHC. (2022). Measures of patient safety culture | Australian Commission on Safety and Quality in Health Care. Www.safetyandquality.gov.au. https://www.safetyandquality.gov.au/our-work/indicators-measurement-and-reporting/patient-safety-culture/measures-patient-safety-culture
AHRQ. (2019, September 7). Culture of Safety | PSNet. Ahrq.gov. https://psnet.ahrq.gov/primer/culture-safety
Australian Commission on Safety and Quality in Health Care. (2019). Clinical Governance Standard | Australian Commission on Safety and Quality in Health Care. Safetyandquality.gov.au. https://www.safetyandquality.gov.au/our-work/clinical-governance/clinical-governance-standard
Garfield, S., & Franklin, B. D. (2016). Understanding models of error and how they apply in clinical practice. The Pharmaceutical Journal, 296(7890). https://doi.org/10.1211/pj.2016.20201110
Khater, W. A., Akhu-Zaheya, L. M., AL-Mahasneh, S. I., & Khater, R. (2014). Nurses’ perceptions of patient safety culture in Jordanian hospitals. International Nursing Review, 62(1), 82–91. https://doi.org/10.1111/inr.12155
Khoshakhlagh, A. H., Khatooni, E., Akbarzadeh, I., Yazdanirad, S., & Sheidaei, A. (2019). Analysis of affecting factors on patient safety culture in public and private hospitals in Iran. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4863-x
McGowan, J., Wojahn, A., & Nicolini, J. R. (2021). Risk Management Event Evaluation and Responsibilities. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559326/
NEJM Catalyst. (2018). What Is Risk Management in Healthcare? The New England Journal of Medicine. https://doi.org//10.1056/CAT.18.0197
O’Daniel, M., & Rosenstein, A. H. (2018). Professional Communication and Team Collaboration. Nih.gov; Agency for Healthcare Research and Quality (US). https://www.ncbi.nlm.nih.gov/books/NBK2637/
Schoenly, L. (2022). Correctional Nurse Professional Practice Update: The Blunt End and Sharp End of Clinical Error. Correctionalnurse.net. https://correctionalnurse.net/making-ends-meet-the-blunt-end-and-sharp-end-of-clinical-error/
Simsekler, M. C. E., Qazi, A., Alalami, M., Ellahham, S., & Ozonoff, A. (2020). Evaluation of Patient Safety Culture Using a Random Forest Algorithm. Reliability Engineering & System Safety, 204, 107186. https://doi.org/10.1016/j.ress.2020.107186
World Health Organization. (2019). Patient Safety. Who.int; World Health Organization: WHO. https://www.who.int/news-room/fact-sheets/detail/patient-safety
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