The Critical Ingredients of a Patient Safety Framework

Trying to select an implement a patient safety framework for your organization, but don't know where to start? How about here, with this week's Datix blog?

The Critical Ingredients Of A Patient Safety Framework

Over the last decade, much has been written about the need for a unified patient safety framework that can support meaningful and tangible improvements in reducing preventable patient harm. One Canadian healthcare organization, Hamilton Health Sciences in Hamilton, Ontario, went so far as to use an approach called the Balanced Scorecard that was designed for corporate strategy development.

The Balanced Scorecard was developed in the 1990s by Harvard B-school professors Drs. David Norton and Robert Kaplan to better focus strategy around four themes: Finance, customer, internal business processes, and learning and growth. Looking for structure to support its goal of zero preventable deaths in four years, Hamilton Health Sciences used the Balanced Scorecard – for better or worse – as its patient safety framework.

A Simplified, Conceptual Model for Patient Safety

In 2008, the Agency for Healthcare Research and Quality (AHRQ), published the book, “Advances in Patient Safety: New Directions and Alternative Approaches,” which sought to simplify patient safety improvement frameworks.

Wrote the authors: “While good models of patient safety have been constructed, we seek an overarching model that is simple, fully authentic to the subject matter, and compatible with the good existing models. At the same time, it should be simple enough that it can be seen in a readily sketched diagram and stated in a simple, short sentence that can be easily recalled. Only such a simple model can ubiquitously permeate the interstices of daily thought among all the necessary people throughout health care.”2

To that end, the authors suggested a simple, conceptual framework with four domains:

  • Those who work in healthcare,
  • Those who receive it or have a stake in its availability,
  • The infrastructure of systems for therapeutic interventions (healthcare delivery processes), and
  • The methods for feedback and continuous improvement.

The idea is that each domain interacts with the others, answering the questions:

  • What is the nature of patient safety?
  • Where does patient safety happen?
  • How is patient safety achieved?
  • Who is a patient safety practitioner?

The IHI Patient Safety Framework

If the AHRQ’s framework doesn’t have enough depth for you, then consider the patient safety framework advanced by the Institute for Healthcare Improvement, which is comprised of two domains – Culture and Learning System – and nine focus areas.

Leadership, which belongs to both domains, focuses on facilitating and mentoring teamwork, improvement, respect, and psychological safety.

Excluding Leadership, the Culture and Learning System domains each include four focus areas. Culture has components for Psychological Safety, Accountability, Teamwork and Communication, and Negotiation. Learning System is comprised of Continuous Learning, Improvement and Measurement, Reliability, and Transparency.

The definitions of these eight focus areas, according to the IHI, are:

The Culture Domain

  • Psychological Safety: Creating an environment where people feel comfortable and have opportunities to raise concerns or ask questions.
  • Accountability: Being held to act in a safe and respectful manner given the training and support to do so.
  • Teamwork & Communication: Developing a shared understanding, anticipation of needs and problems, agreed methods to manage these as well as conflict situations.
  • Negotiation: Gaining genuine agreement on matters of importance to team members, patients and families.

The Learning System Domain

  • Continuous Learning: Regularly collecting and learning from defects and successes.
  • Improvement & Measurement: Improving work processes and patient outcomes using standard improvement tools including measurements over time.
  • Reliability: Applying best evidence and minimizing non-patient specific variation with the goal of failure free operation over time.
  • Transparency: Openly sharing data and other information concerning safe, respectful and reliable care with staff and partners and families.

Regardless of the patient safety framework selected and adopted by your organization, one thing is clear. Without a framework, the ability to reduce preventable patient harm becomes a hit-or-miss endeavor that lacks a consistent strategy so critical to short- and long-term success.