Safety Strategies in Hospitals

Abstract

We have developed a series of ideas and proposals in the book which together laid the foundations for fi ve safety strategies described in Chap. 6 . We believe that thinking of safety strategies in this way has three major advantages: fi rst, we can enlarge the range of safety strategies and interventions available to us; secondly we can customise the blend of strategies to different contexts and third the high level architecture of safety strategies may help us think more strategically about safety both day to day and on a long term basisIn this chapter we begin the process of exploring how these strategies might support safety in the hospital. The following chapters address home care and primary care. In each case we provide a short introduction to relevant aspects of safety in each context but do not dwell on well-established fi ndings. Our primary purpose is to provide examples of interventions associated with each of the fi ve strategies and to give a sense of the potential value of such an approach. We recognise that, in the longer term, considerable further empirical work would be needed to develop and confi rm (or discount) our proposals. A Little HistoryHospital care has been the main focus of patient safety for two decades now and we can distinguish a series of phases of exploration and intervention. Each phase brought some success but simultaneously revealed barriers and limitations, which in turn stimulated a new phase of work in an evolving trial and error strategy. With experience and maturity, we understand more today about what is achievable and what has proved illusory. We are much more aware of how diffi cult it is to improve safety in both the short and long term.What has been done in past decades? In the past 15 years we can distinguish three main phases each associated with different types of action and intervention. The earlier strategies have continued as the new ones emerged so that we now have 'a safety layer cake' of practices and interventions. The Enthusiasm of the Early Years, 1995-2002Systematic work on patient safety began in the mid 1990s with an emerging demarcation between a broad concern with quality and a specifi c focus on harm. In Britain for instance the development of clinical risk management, initially targeted at the reduction of litigation, brought a new emphasis on the analysis and reduction of harmful incidents and events (Vincent 1995 ). The methods and assumptions however remained rooted in those of quality improvement; the aim was to identify and count errors and incidents and then fi nd ways of preventing them. Establishing reporting systems to detect and record incidents was at the core of the strategy. This approach was rapidly reconsidered as a result of both massive under-reporting, especially from doctors, and a gradual realisation of the impossibility of resolving the growing number of problems identifi ed in reporting systems (Stanhope et al. 1999 ). A wider vision was needed which was provided by systemic concepts and tools imported from industry. The Adv...

Exploring links between resilience and the macro-level development of healthcare regulation- a Norwegian case study

“…Vincent and Amalberti [85] describe safety as a moving target, constantly shifting with progress in innovation and prevention. Although workarounds are often developed in relation to problems in hospital environments, there is a need to develop these strategies of adaptation from local and informal improvisation into broader system-wide capacities [46]. We found an expectation of that the Quality Improvement Regulation would contribute to building adaptive capacity into the system it regulates, both prior to and when challenges and changes arise.…”

“…Different forms of regulatory activity can be conceptualized as a pyramid of regulatory strategies that are responsive to different degrees and forms of risk [45], with less coercive strategies at the bottom (such as self-regulation independent of government activity, see Table 1 for clarification) and more interventionistic strategies at the top (for instance, prosecution). According to Vincent and Amalberti [46], different approaches to quality and safety can vary due to the need for standardization and control on the one hand and adaptability on the other. Because healthcare is complex with different types of activities and clinical settings it is not possible to rely on one "primary model" [46].…”

“…According to Vincent and Amalberti [46], different approaches to quality and safety can vary due to the need for standardization and control on the one hand and adaptability on the other. Because healthcare is complex with different types of activities and clinical settings it is not possible to rely on one "primary model" [46]. It is a demanding task to develop detailed rules and regulations that would fit many different organizational contexts, so regulators commonly leave details and specific decisions on how to manage safety and quality up to the regulatee [47].…”

“…In this study, we specifically considered that adaptation to variation is a necessary component of safety, and that efforts to manage and improve quality depend on adaptation to local conditions and context. The degree and type of adaptation that may be required depends on the specific hospital setting and quality challenges that are being faced [46]. Berg and Aase [54] identify empirical studies of adaptive capacities at different levels.…”

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“…The quality and safety of patient care is an international policy issue with care quality requiring improvement (Vincent & Amalberti, ). In many countries including Ireland, adverse findings from healthcare regulatory investigations highlight the importance of measuring care quality and have brought public attention to the urgent need to measure, improve and provide data to ensure quality and safety in healthcare (Health Information & Quality Authority, , ; Health Service Executive, ).…”