Delivering safe health care: safety is a patient’s right and the obligation of all health professionals (original) (raw)
The systems approach to medicine: controversy and misconceptions
BMJ Quality & Safety, 2014
The 'systems approach' to patient safety in healthcare has recently led to questions about its ethics and practical utility. In this viewpoint, we clarify the systems approach by examining two popular misunderstandings of it: (1) the systematisation and standardisation of practice, which reduces actor autonomy; (2) an approach that seeks explanations for success and failure outside of individual people. We argue that both giving people a procedure to follow and blaming the system when things go wrong misconstrue the systems approach.
Archives of Disease in Childhood
Healthcare systems across the world and especially those in low-resource settings (LRS) are under pressure and one of the first priorities must be to prevent any harm done while trying to deliver care. Health care workers, especially department leaders, need the diagnostic abilities to identify local safety concerns and design actions that benefit their patients. We draw on concepts from the safety sciences that are less well-known than mainstream quality improvement techniques in LRS. We use these to illustrate how to analyse the complex interactions between resources and tools, the organisation of tasks and the norms that may govern behaviours, together with the strengths and vulnerabilities of systems. All interact to influence care and outcomes. To employ these techniques leaders will need to focus on the best attainable standards of care, build trust and shift away from the blame culture that undermines improvement. Health worker education should include development of the tech...
Systems Thinking and Patient Safety
2005
Patient safety is a prominent theme in health care delivery today. This should come as no surprise, given that "first, do no harm" has been the ethical watchword throughout the history of medicine, nursing, and pharmacy. In recent years, we have become increasingly aware of the magnitude of our failure to successfully live up to this ethical imperative. We have also become increasingly aware of techniques that we might employ to bring reality closer to the ideal of doing no (preventable) harm. The realization of the magnitude of this failure and that there are potential routes to reducing harm has fortunately resulted in both a burgeoning of research in the area of patient safety and a willingness to invest in patient safety research. This volume-published by the Agency for Healthcare Research and Quality (AHRQ) with support from the U.S. Department of Defense-along with its three companion volumes, is testimony to this blossoming of research and funding.
False Dawns and New Horizons in Patient Safety Research and Practice
International journal of health policy and management, 2017
In response to a weight of evidence that patients are frequently harmed as a result of their care, there have been concerted efforts to make healthcare safer, with health systems across the globe investing significant resources in policies and programmes designed to reduce adverse events. Yet, despite extensive efforts, improvements in safety have proved difficult to sustain and spread, with studies confirming there has been no measurable, systems-level improvement in the overall rates of preventable harm. Here, we highlight the limitations of the thinking which underpins current efforts to make healthcare systems safer and point to new and emerging approaches to understanding and addressing patient safety in complex, dynamic health systems.
Sociology, Systems and (Patient) Safety: Knowledge Translations in Health Care Policy
Sociology of Health and Illness, 2008
In 2000 the American Institute of Medicine, adviser to the federal government on policy matters relating to the health of the public, published the report To Err is Human: Building a Safer Health System, which was to become a call to arms for improving patient safety across the Western world. By re-conceiving healthcare as a system, it was argued that it was possible to transform the current culture of blame, which made individuals take defensive precautions against being assigned responsibility for error – notably by not reporting adverse events, into a culture of safety. The IOM report draws on several prominent social scientists in accomplishing this re-conceptualisation. But the analyses of these authors are not immediately relevant for health policy. It requires knowledge translation to make them so. This paper analyses the process of translation. The discussion is especially pertinent due to a certain looping effect between social science research and policy concerns. The case here presented is thus doubly illustrative: exemplifying first how social science is translated into health policy and secondly how the transformation required for this to function is taken as an analytical improvement that can in turn be redeployed in social research.
A Socio Cultural Perspective on Patient Safety Foreword
Socio-cultural Perspective on Patient Safety, 2015
It seems that despite unprecedented levels of spending, preventable medical errors abound, uncoordinated care continues to frustrate patients and providers, and health care costs continue to rise. Although there has never been more awareness and resources devoted worldwide to overall system improvement, care experience, quality and safety, while advocating for system-wide culture change, there remain opportunities to achieve savings, reduce risks and improve performance. Current approaches are not producing the pace, breadth, or magnitude of improvement that patients demand and providers expect. Proscriptive rules, guidelines and checklists are helping to raise awareness and present some harm but are falling short from helping to provide an ultrasafe system (Amalberti et al. 2005). A new system centered around the patient and their clinical microsystem that renders clinical care processes more predictable, effective, efficient and humane is needed (Mohr et al. 2004).
False Dawns and New Horizons in Patient Safety Research and Practice Editorial
2017
In response to a weight of evidence that patients are frequently harmed as a result of their care, there have been concerted efforts to make healthcare safer, with health systems across the globe investing significant resources in policies and programmes designed to reduce adverse events. Yet, despite extensive efforts, improvements in safety have proved difficult to sustain and spread, with studies confirming there has been no measurable, systems-level improvement in the overall rates of preventable harm. Here, we highlight the limitations of the thinking which underpins current efforts to make healthcare systems safer and point to new and emerging approaches to understanding and addressing patient safety in complex, dynamic health systems. Citation: Mannion R, Braithwaite J. False dawns and new horizons in patient safety research and practice.