Abstract

Patient safety is recognized as a global public health issue, (1) causing death and suffering in all types of patients and incurring costs in all countries. The global health community has made significant and sustained efforts to improve safety and quality of health services. However, progress in reducing preventable harm has been too limited, little and local. (2) Here, we propose that narratives or mental models are reasons for the limited progress. Narratives inform how we interpret reality and how to act in the world and those told about patient safety and poor quality care often inhibit rather than facilitate momentum to make changes. (3) In this paper, we discuss how changing these narratives may accelerate the efforts to improve safety and quality of care. One narrative is that patient harm is inevitable. There is limited systematic evidence, from a large number of countries, describing which harms are measured in health-care studies and which harms are the focuses of national policies to prevent them. Nevertheless, preventable harm has been identified as a significant problem in all care settings. (4, 5) While harm is usually focused on disabling injury or death from medical care, we also include here the less tangible harms, in which patients feel disrespected. Nonetheless, a fatalistic story reinforces the status quo and frustrates efforts to better understand complex health-care systems and how to make them safer. In addition, assuming that harm is inevitable may partially explain the lack of national and global measures of patient harm, the widely varying estimates of the scope of the problem, and the gap between the scope of the problem and investments in resolving the problems. In particular, the belief that harm is inevitable hinders needed investments in transdisciplinary research to better understand what it means for a harm to be preventable in a complex context. The researchers also need to know the scale of the problem and what fundamental mechanisms are needed to improve safety and quality of care. A second narrative is that clinicians are responsible for safety and their behaviours are the main targets for change. Yet evidence shows that no matter how hard an individual works to keep patients safe, poor systems may defeat them. Health-care organizations might have technologies with low usability and absent interoperability, underspecified work processes, immature and variable safety training, poorly developed management systems and opaque and ambiguous accountability mechanisms. Too often, clinicians work in systems that are not well designed and operationally are managed poorly. Too often, patient priorities and their experiences across the continuum-of-care are rarely considered when designing systems. Too often, policy-makers and managers execute extrinsic incentives instead of capitalizing on the intrinsic motivation of professionals. The policymakers remain rooted in a hierarchical system rather than forming a system that balances independence and interdependence, enabling a foundation for improvement and valuing professional instincts. (6) Health care is starting to change this narrative. Some notable improvements have occurred for hand hygiene adherence and bloodstream infections. (7, 8) A third narrative is that each organization should solve their patient safety problems alone. Individual organizations can achieve much--especially when they are highly intentional, committed and energetic--but single-organizational efforts can paradoxically introduce new risks by undermining standardization and coordination between hospitals and/or countries. However, when many people and institutional actors are involved in a collective activity, responsibility can be scattered and obscured. This might hinder large-scale coordination that is needed to solve many sorts of safety problems. (9) Yet this challenge can be overcome by adapting strategies from other high-risk industries. …

Highlights

  • Patient safety is recognized as a global public health issue,[1] causing death and suffering in all types of patients and incurring costs in all countries

  • Preventable harm has been identified as a significant problem in all care settings.[4,5]

  • Perspectives Patient safety narratives and medication errors at home. Any such change should avoid transferring the responsibility to patients to keep themselves safe, whether they are in the hospital and vulnerable, or at home. These narratives are slowly changing, patient safety and quality of care need new narratives that liberate the constraints of current narratives and theories and emphasize the collective nature of the efforts required to learn and improve

Read more

Summary

Introduction

Patient safety is recognized as a global public health issue,[1] causing death and suffering in all types of patients and incurring costs in all countries. Health-care researchers have studied the sector-wide, collective improvement efforts achieved in other high-risk industries, recognizing that systems engineering is needed to create integrated and holistic approaches to ensuring safety and reliability.[10] What will likely be more effective is adaption of the safety management systems or operating management systems that high-risk industries use to integrate their approaches to safety and quality.[11] The health-care sector is beginning to adopt high-reliability organizing principles from other industries.[12]

Results
Conclusion

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call

Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.