Prioritization of patient safety health policies: Delphi survey using patient safety experts in Japan

Abstract

Various patient safety interventions have been implemented since the late 1990s, but their evaluation has been lacking. To obtain basic information for prioritizing patient safety interventions, this study aimed to extract high-priority interventions in Japan and to identify the factors that influence the setting of priority. Six perspectives (contribution, dissemination, impact, cost, urgency, and priority) on 42 patient safety interventions classified into 3 levels (system, organizational, and clinical) were evaluated by Japanese experts using the Delphi technique. We examined the relationships of the levels and the perspectives on interventions with the transition of the consensus state in rounds 1 and 3. After extracting the high-priority interventions, a chi-squared test was used to examine the relationship of the levels and the impact/cost ratio with high priority. Regression models were used to examine the influence of each perspective on priority. There was a significant relationship between the level of interventions and the transition of the consensus state (p = 0.033). System-level interventions had a low probability of achieving consensus. “Human resources interventions,” “professional education and training,” “medication management/reconciliation protocols,” “pay-for performance (P4P) schemes and financing for safety,” “digital technology solutions to improve safety,” and “hand hygiene initiatives” were extracted as high-priority interventions. The level and the impact/cost ratio of interventions had no significant relationships with high priority. In the regression model, dissemination and impact had an influence on priority (β = -0.628 and 0.941, respectively; adjusted R-squared = 0.646). The influence of impact and dissemination on the priority of interventions suggests that it is important to examine the dissemination degree and impact of interventions in each country for prioritizing interventions.

Difference in prioritization of patient safety interventions between experts and patient safety managers in Japan

“…All these interventions had low scores for past contribution and current dissemination, as evaluated by safety managers. Our previous study on Japanese patient safety experts suggested that experts are likely to evaluate the priority of patient safety interventions with the expected impact in the future [ 20 ]. These results suggest that safety managers were likely to evaluate the priority of patient safety interventions in terms of which interventions were effective and important in the past, while experts were likely to evaluate what was lacking now for further improvement in patient safety.…”

“…We performed a secondary data analysis of two surveys: the Delphi survey for Japanese experts [ 20 ] and a nationwide questionnaire survey for patient safety managers in hospitals [ 23 ]. Parts of both questionnaire items used in this study were shown in S1 and S2 Tables.…”

“…In each round, participants were asked to rate all 42 interventions on a 5-point Likert scale from two perspectives: dissemination (1: low to 5: high) and priority (1: low to 5: high). Ratings of past contributions were asked in round 1 only (1: small to 5: large) [ 20 ].…”

“…By conducting a Delphi survey of Japanese patient safety experts, Hatakeyama et al extracted patient safety interventions that should be prioritized in Japan [ 20 ]. In this study, the questionnaire consisted of 42 interventions based on the OECD report, and 6 perspectives for assessing the importance of interventions in the past (contribution), current (dissemination), and future (impact, cost, urgency, and priority).…”