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

Yosuke Hatakeyama,Shuhei Iida,Shigeru Fujita,Yoshiko Shimamori,Yoji Nagai,Kanako Seto,Ryo Onishi,Junko Ayuzawa,Kunichika Matsumoto,Tomohiro Hirao,Tomonori Hasegawa

doi:10.1371/journal.pone.0239179

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.

Highlights

Patient safety has been a global concern against the background of the occurrence of serious adverse events since the late 1990s [1]
The Delphi technique was used for obtaining a consensus on patient safety interventions from patient safety experts
By using the Delphi technique to summarize the opinions of patient safety experts, this study extracted high-priority patient safety interventions and examined the influence of perspectives on the priority of patient safety interventions

Summary

Introduction

Patient safety has been a global concern against the background of the occurrence of serious adverse events since the late 1990s [1]. Various activities have been introduced by governments, medical/specialty societies, accreditation bodies, and healthcare organizations in many countries, such as incident reporting, training and deployment of safety managers, standardization of care, and changes to payment schemes [3]. In 2002, the General Policy for Medical Safety was published by the Ministry of Health, Labour and Welfare. It stressed the importance of a systematic approach for securing safe workplace environments, and cultivating a patient safety culture. A nationwide adverse event reporting system was introduced (2004 for accidents, 2005 for close calls). It is one of the biggest databases of adverse events in the world. The hospital chief executive officer has to report any lethal case possibly due to an adverse event to a third-party organization (the Adverse Event Investigation and Support Center), conduct an in-hospital investigation, and submit the report along with preventive methods to the organization

Methods

Discussion

Conclusion