Contributions to the Portuguese National Plan for Patient Safety 2021–2026: A Robust Methodology Based on the Mixed-Method Approach

Abstract

<b><i>Introduction:</i></b> Several countries prioritize patient safety in their health policies. In Portugal, following the implementation of the National Plan for Patient Safety (NPPS) 2015–2020, the research team of the National School of Public Health (NSPH) carried out extensive work to continue improving aspects of the previous Plan. This work was focused on identifying the strengths and weaknesses of NPPS 2015–2020 and aspects related to its applicability and main challenges and opportunities for the implementation of the NPPS 2021–2026. <b><i>Methods:</i></b> Methodological dynamic process was based on the most relevant international and national guidelines and the feedback from key patient safety stakeholders. We developed a cross-sectional mixed-methods study from January to August 2021. We used documentation and periodical reports from National Health Service (NHS) healthcare institutions as secondary sources of information. For primary data collection, we used an online survey (applied to elements in the different quality and safety structures of hospitals and primary care units), interviews, and focus groups to collect information from patient safety experts. <b><i>Results and Discussion:</i></b> Strengthening safety culture, patient safety training, communication, leadership involvement, patient and family engagement, and monitorization process is considered essential. We also identified local limitations such as the lack of resources and protected time for the healthcare professionals and lack of leadership involvement on patient safety strategies for dedicating to patient safety actions. Most of the patient safety stakeholders agreed that the safety and health of clinical teams and new modalities of healthcare (such as telemedicine, home hospitalization, home care) should be a priority for patient safety strategies. <b><i>Conclusions:</i></b> In our study, we used a robust methodology with a participatory process involving different stakeholders. An alignment between local, regional, and national levels in terms of measuring indicators, the definition of priorities, and actions and activities to improve patient safety is recommended. Reinforced partnerships and alignment between the institution’s mission, and safety priorities will be crucial to enhance patient safety. Additionally, this work highlights the added value for health systems achieved through strong partnerships between public administration and academic institutions to improve healthcare quality and patient safety.

Patient safety culture in nurses’ clinical practice

“…Some studies show that a mean of 1 out of every 10 patients undergoes an adverse event in terms of receiving hospital care (2) . The 2021-2026 national plan for patient safety in Portugal reinforced the importance of promoting patient safety in a coordinated and persistent effort by all managers, mid-level leaders and health professionals to improve public awareness towards patient safety topics (3) . It is fundamental to analyse the real problems related to safe practices in care environments and the Hospital Survey on Patient Safety Culture (HSOPSC), developed by the Agency for Healthcare Research and Quality (AHRQ), allows assessing the safety culture, by measuring multiple dimensions related to values, beliefs, organizational norms, reporting of adverse events, communication, leadership and management (4) .…”

“…If we check the data from the safety culture assessment at the national level that was performed in 2018, we find that some dimensions still need urgent intervention, specifically Frequency of events reported, Staffing and Non-punitive response to error (8) . If we refer to the evaluation of aspects related to the Portuguese national plan for patient safety until 2020, we find that there are communication failures between the various structures/departments of the health institutions, lack of involvement by professionals, specialists and patients in patient safety actions, lack of proximity and interaction between management, services and health professionals, and absence of legislation providing confidentiality and protection to the professionals involved in the notification of an adverse event (3) .…”

Cultura de seguridad del paciente en la práctica clínica de enfermería

“…Algunos estudios muestran que, en promedio, 1 de cada 10 pacientes está sujeto a un evento adverso mientras recibe atención hospitalaria (2) . El plan nacional para la seguridad del paciente 2021-2026 en Portugal reforzó la importancia de promover la seguridad del paciente en un esfuerzo coordinado y constante de todos los gestores, mandos intermedios y profesionales de la salud para mejorar la conciencia pública sobre los temas de seguridad del paciente (3) . Es fundamental analizar los problemas reales relacionados con las prácticas seguras en los entornos asistenciales y la Hospital Survey on Patient Safety Culture (HSOPSC), desarrollada por la Agency for Healthcare Research and Quality (AHRQ), permite evaluar la cultura de seguridad, realizando la medición de múltiples dimensiones relacionadas con valores, creencias, normas organizacionales, notificaciones de eventos adversos, comunicación, liderazgo y gestión (4) .…”

Cultura de segurança do doente na prática clínica dos enfermeiros

“…Alguns estudos mostram que, em média, 1 em cada 10 doentes está sujeito a um evento adverso enquanto recebe cuidados hospitalares (2) . O plano nacional de segurança do doente 2021-2026 em Portugal, veio reforçar a importância da promoção da segurança do doente num esforço coordenado e persistente de todos os gestores, lideranças intermédias e profissionais de saúde, para melhorar a conscientização pública sobre os tópicos de segurança do doente (3) . É fundamental analisar os problemas reais relacionados com as práticas seguras nos ambientes de cuidados e o Hospital Survey on Patient Safety Culture (HSOPSC), desenvolvido pela Agency for Healthcare Research and Quality (AHRQ), permite efetuar a avaliação da cultura de segurança, efetuando a mensuração de múltiplas dimensões relacionadas com valores, crenças, normas da organização, notificação de eventos adversos, comunicação, liderança e gestão (4) .…”

“…Se verificarmos os dados da avaliação da cultura de segurança a nível nacional decorrida em 2018, constatamos que existem dimensões que continuam a necessitar de intervenção urgente, concretamente a frequência da notificação de eventos, dotação de profissionais e resposta ao erro não punitiva (8) . Se nos reportarmos à avaliação dos aspetos relacionados com o Plano Nacional Português de Segurança do Doente até 2020, apuramos que existem falhas de comunicação entre as diversas estruturas/departamentos das instituições de saúde, falta de envolvimento dos profissionais, especialistas e doentes nas ações de segurança do paciente, falta de proximidade e interação entre direção, serviços e profissionais da saúde, ausência de legislação que forneça confidencialidade e proteção aos profissionais envolvidos na notificação de um evento adverso (3) .…”