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16/03/2011 L. Macchi, 2011
Review of approaches for safety management: available models and systems
16/03/2011 L. Macchi, 2011
Background
This work is part of the projectPatient safety as an asset in social and health care (SafetyAsset)[1].
[1] Potilasturvallisuus laatu- ja kilpailuvaltiksi (POTILASTURVA)
Aims to:1. develop a model for patient safety management, that is client-centred
and takes into consideration the complexity of the health care organizational network, continuity of care and the well-being of the personnel;
2. develop tools that support patient involvement in the process of care, organizational learning, proactive risk assessment and development of overall safety;
3. promote distribution of good practices in patient safety management in Finland;
4. promote development of innovative services and products in relation to patient safety management
16/03/2011 L. Macchi, 2011
Patient safety management: basic concepts
Patient safety: what the desired result of safety management is. Safety can be understood in several different ways, and this influences the manner in which safety is going to be pursued
16/03/2011 L. Macchi, 2011
Patient safety management: basic concepts
Patient safety: what the desired result of safety management is. Safety can be understood in several different ways, and this influences the manner in which safety is going to be pursued
Safety model: logical description of what makes a system safe or – on the other hand – what makes it unsafe
16/03/2011 L. Macchi, 2011
Patient safety management: basic concepts
Patient safety: what the desired result of safety management is. Safety can be understood in several different ways, and this influences the manner in which safety is going to be pursued
Safety model: logical description of what makes a system safe or – on the other hand – what makes it unsafe
Safety management model: the background assumptions an organisation has about the management and improvement of safety.
16/03/2011 L. Macchi, 2011
Patient safety management: basic concepts
Patient safety: what the desired result of safety management is. Safety can be understood in several different ways, and this influences the manner in which safety is going to be pursued
Safety model: logical description of what makes a system safe or – on the other hand – what makes it unsafe
Safety management model: the background assumptions an organisation has about the management and improvement of safety.
Safety management system: collection of systematic organisational processes that are needed in order to steer the organisation to ensure and develop patient safety.
16/03/2011 L. Macchi, 2011
Patient safety
16/03/2011 L. Macchi, 2011
Patient safety: the desired result of safety management
Describe which aspects are relevant for safetyWhich elements? Which efforts?What to do to improve safety?
16/03/2011 L. Macchi, 2011
Patient safety: the desired result of safety management
Describe which aspects are relevant for safetyWhich elements? Which efforts?What to do to improve safety?
Freedom from harm
Incidents caused by someone or something breaking the protection
measures.
Safety is achieved by designing and implementing robust protection measures.
(Kohn et al, 2000; Sundt, T.M., 2005; Lyons, M., 2007;Conklin, A. et al, 2008).
16/03/2011 L. Macchi, 2011
Patient safety: the desired result of safety management
Describe which aspects are relevant for safetyWhich elements? Which efforts?What to do to improve safety?
Freedom from harm
Incidents caused by someone or something breaking the protection
measures.
Safety is achieved by designing and implementing robust protection measures.
(Kohn et al, 2000; Sundt, T.M., 2005; Lyons, M., 2007;Conklin, A. et al, 2008).
It is needed to identify ALL the potential ways in which incidents may
happen
The complexity of health care
organisations makes this task practically
impossible
16/03/2011 L. Macchi, 2011
Patient safety: the desired result of safety management
Describe which aspects are relevant for safetyWhich elements? Which efforts?What to do to improve safety?
Dynamic property emerging from the interactions of many elements
Incidents result from the ineffective interactions between the actors.
Safety is created by the organisation, in its normal way of functioning
(Grasha, 2002; Cook, et al, 2005; Vincente, 2006; Emanuel, et al. 2008; Wiig. and Lindøe, 2009).
Freedom from harm
Incidents caused by someone or something breaking the protection measures.
Safety is achieved by designing and implementing robust protection measures.
(Kohn et al, 2000; Sundt, T.M., 2005; Lyons, M., 2007;Conklin, A. et al, 2008).
16/03/2011 L. Macchi, 2011
Patient safety: the desired result of safety management
Describe which aspects are relevant for safetyWhich elements? Which efforts?What to do to improve safety?
Dynamic property emerging from the interactions of many elements
Incidents result from the ineffective interactions between the actors.
Safety is created by the organisation, in its normal way of functioning
(Grasha, 2002; Cook, et al, 2005; Vincente, 2006; Emanuel, et al. 2008; Wiig. and Lindøe, 2009).
It is needed to understand the normal
organisational functioning in order to enhance the ability of
the organisation to perform and create
safety.
16/03/2011 L. Macchi, 2011
Safety model
16/03/2011 L. Macchi, 2011
Safety model: description of what makes a system safe/unsafe
Describe the background assumptions guiding the understanding of how an organisation functions and/or fails.
Upon safety model it is based: the anticipation of unwanted eventsthe measures to ensure the safe functioning.
16/03/2011 L. Macchi, 2011
Safety model: description of what makes a system safe/unsafe
Describe the background assumptions guiding the understanding of how an organisation functions and/or fails.
Upon safety model it is based: the anticipation of unwanted eventsthe measures to ensure the safe functioning.
Linear models
Emphasis on the sharp endCausal thinking: linear cause-effectAccidents are caused by a combination of events
16/03/2011 L. Macchi, 2011
Safety model: description of what makes a system safe/unsafe
Describe the background assumptions guiding the understanding of how an organisation functions and/or fails.
Upon safety model it is based: the anticipation of unwanted eventsthe measures to ensure the safe functioning.
Non-linear models
•Emphasis on the organisation and its dynamics;
•Question the linear causal thinking to explain accidents
•Arguing for the development of the normal functioning of the organisation jointly with prevention of incidents and accidents
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Safety management model
16/03/2011 L. Macchi, 2011
assumptions about how to manage safety
It addresses (e.g.): the unit of analysis, the concepts and means needed to develop safety, the way in which safety management is integrated in the overall management of the organisation, the phenomena to be considered in the development of a safety management system
Safety Management Model:
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Supporting all hospitals by implementing a patient safety management system so that they all have a certified system in December 2012
The Dutch approach:Develop basic requirements for the patient safety management systemDevelop material and training for hospitals to support implementation of SMSSupport hospitals in reducing preventable harm
Requirements for patient safety: LeadershipCommunicationEmployeesParticipation of patientsProspective risk analysisOperational control measuresChange-managementIncident reporting and retrospective risk analysisMonitoring of resultsImprovements of the safety of health care
Safety Management Model: The Netherlands
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National Patient Safety Agency’s 7 steps for patient safety:Step 1: Build a safety culture. Carry out an audit to assess safety culture.
Step 2: Lead and support your practice team. Talk about the importance of patient safety; demonstrate you are trying to improve it
Step 3: Integrate your risk management activity. Regularly review patient records
Step 4: Promote reporting. Share patient safety incidents
Step 5: Involve and communicate with patients and the public. Seek patient views; Encourage feedback using patient surveys
Step 6: Learn and share safety lessons. Hold regular Significant Event Audit meetings
Step 7: Implement solutions to prevent harm. Ensure that agreed actions are documented, actioned and reviewed, and agree who should take responsibility
Safety Management Model: United Kingdom
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Management commitment: management shall define the strategy for develop safety, the plan for continuous improvements etc.
Development of a supportive climate: an open and non-blaming climate within the organisation as the precondition for reporting and discussing accidents and for organisational learning;
Definition of structures for patient safety: set guidelines for system’s organisation, resources allocation, responsibility among actors, reporting of events etc.;
Definition of the role of the patient: if and how the patient can be involved in managing safety has to be addressed in the safety management model;
Definition of processes: address the way in which things are done and not only what their result is. This includes the development of procedures, technical and non-technical skills, etc.;
Integration of safety management: define how safety management is integrated with other management functions (occupational safety, economics, information safety, production etc.
Safety Management Model: SafetyAsset (preliminary elements)
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Safety management system
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Safety Management Systems:
Collection of systematic organisational processes that are needed in order to steer the organisation to ensure and develop patient safety.
Objective:to provide a structured management approach to control risks in operations and to enhance the ability of the organisation to function in a safe manner.
Typically, they include processes for:planning,organising,communicating providing directions for protection from risks and for organisational development.
These processes are implemented across the organisation and they have to take into consideration the operational and structural characteristics of the organisation
processes to develop patient safety
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Safety management system: Autralia
A SMS is interlinked with other activities for managing risk and is embedded in the organisation’s culture.
A SMS is a systematic, explicit, and comprehensive process for managing the risks that patients face in a health care setting. A SMS has the following attributes:
the discovery and assessment of the hazards of particular operationsthe specification of how these hazards are to be managedwhat is to be done if things go wrong
Levels of accountability:CEOs and Executive: accountable for patient safety in their area of responsibility.Managers/Clinician Managers: accountable for actions in their work area, including the operations of their teams
Health care Professionals: accountable for their own individual actions.Patients and their carers: assume a degree of responsibility for themselves to reduce their exposure to safety risks
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Safety management system: Italy
Definition of roles in local agencies:Clinical risk manager: promoter of the clinical risk management culture and activities among cliniciansPatient safety manager: responsible for the implementation of the action plan and recommendations about clinical risk managementForensic medical doctor: responsible for the Observatory for claims
Building a Clinical risk management systemIdentification of risksAnalysis of clinical risks and safety management
Promoting campaigns for patient safetyFocus on well known risks for patient safety
Creating Clinical Risk management LaboratoriesIdentify the most critical activities in specific areas, where adverse events are particularly high
16/03/2011 L. Macchi, 2011
Messages and recommendations
16/03/2011 L. Macchi, 2011
Messages and recommendations
1. An organisation should explicitly define patient safety, safety model and safety management model.
2. Safety definition, safety model, safety management model and safety management system should be coherent with each other.
16/03/2011 L. Macchi, 2011
Messages and recommendations
Safety definition:Patient safety is an ability of an organisation to function safely. Patient safety emerges from the social and technological factors interacting in an organisation. An organisation does patient safety. To improve patient safety, emphasis should be on creating prerequisites for safe work in the organization. In the provision of safe services, some degree of flexibility is required. Providing safe services to patients cannot be done only by ensuring that things are done exactly the same way every time.There is a limit to what standardising procedures can contribute to patient safety.
16/03/2011 L. Macchi, 2011
Messages and recommendations
Safety modelSafety model should represent patient safety as a systemic phenomenon. Adopting a systemic approach means that the safety model shall consider both successful and unsuccessful events as emerging from the same organisational behaviour. The systemic approach puts emphasis on non-linear interactions within the organisation and with the environment.
16/03/2011 L. Macchi, 2011
Messages and recommendations
Safety management modelSafety management model should be in line with both the definition of patient safety and the safety model. It identifies the elements necessary for the management and improvement of patient safety.A safety management model should include elements for both protecting from risks and enhancing prerequisites for safe functioning. Safety should be considered together with the overall management of the organisation.
16/03/2011 L. Macchi, 2011
Messages and recommendations
Safety management systemA safety management system has to be integrated in the management system of the organisation. A safety management system should aim not only at assessing and eliminating risks, but also at ensuring that the appropriate prerequisites are present throughout the lifetime of the organisation.A safety management system shall be developed taking into account the specific characteristics of should organisation. A safety management system shall be documented.
16/03/2011 L. Macchi, 2011
Thank you for your attention.