Advancing the Science of Patient Safety

Abstract

Despite a decade's worth of effort, patient safety has improved slowly, in part because of the limited evidence base for the development and widespread dissemination of successful patient safety practices. The Agency for Healthcare Research and Quality sponsored an international group of experts in patient safety and evaluation methods to develop criteria to improve the design, evaluation, and reporting of practice research in patient safety. This article reports the findings and recommendations of this group, which include greater use of theory and logic models, more detailed descriptions of interventions and their implementation, enhanced explanation of desired and unintended outcomes, and better description and measurement of context and of how context influences interventions. Using these criteria and measuring and reporting contexts will improve the science of patient safety.

An overview of quality and safety in health care

“…61 Their messages are unsurprising: As with research of any sort, one should start with a plausible and logical construct; the intervention and its implementation should be described in sufficient detail for others to replicate the work; outcomes should be clearly defined, and the context in which the research has been conducted should be described (e.g., an initiative of value in a major teaching hospital may or may not prove worthwhile in a small private institution).…”

“…ont présenté un résumé très bien conçu des questions dont il faut tenir compte dans les recherches qui évaluent les initiatives de qualité et de sécurité dans les soins de santé. 61 Leurs messages sont sans surprise : comme dans toute recherche, il faut commencer par un concept plausible et logique; l'intervention et sa mise en oeuvre doivent être décrites de manière suffisamment détaillée afin que d'autres puissent reproduire le travail; les résultats doivent être clairement définis, et le contexte dans lequel les recherches ont été réalisées doit être décrit (par ex. une initiative efficace dans un hôpital universitaire pourrait être utile ou non dans une petite institution privée).…”

Safety Strategies in Hospitals

“…There was also huge variability between hospitals, within clinical disciplines and across different settings (Tsai et al 2013 ). Whereas safety culture was initially seen as potentially directly impacting on safety, there was now a growing awareness that it might provide only a necessary foundation (Flin et al 2006 ;Vincent et al 2010 ) However, as we have discussed, evidence began to emerge of marked improvements in specifi c safety problems at a local level and of the potential of wider application of approaches such as checklists, care bundles and so on (Haynes et al 2009 ;Shekelle et al 2011 ). Those proven safety wins on the frontline encouraged the healthcare community to believe that safety would progressively improve as more interventions were put into place.…”

Strategies for Safety

“…We originally conceptualised this approach as 'aspiring to standards' as we regard basic standards and procedures as the foundation of safe systems, though we recognise that for an individual patient there is a great deal more to optimal care than achieving standards. In our terms 'best practice' suggests that a team or organisation aims and believes that they can provide care at levels 1 and 2 (Table 6.1 ) A recent review of the patient safety literature (Shekelle et al 2011 ) found only ten interventions that could be currently recommended for implementation; almost all of them would, in our terms, be described as focal safety interventions. The essential idea is that complying with proven evidence and standards will produce optimal quality and safety.…”