environmental scan of patient safety education in alberta ......environmental scan of patient safety...

EnvironmentalScanofPatientSafetyEducationinAlberta’sPost‐SecondaryEducationSector

July 2010

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Environmental Scan of Patient Safety Education in Alberta’s Post-Secondary Education Sector

Acknowledgements 3

Executive Summary 4

Background 7

Purpose 7

Method 8

Results 10

Key Findings by Objective 14

Discussion 17

Conclusion 18

References 19

Appendix 1: Healthcare Encounter Safety and Quality Model 20

Appendix 2: Draft Patient Safety Education Self-Assessment Tool 22

Appendix 3: Information Provided to Participants About the Environmental Scan 28

Appendix 4: Feedback About the Self-Assessment Tool and Process 32

Appendix 5: Scale Ratings and Aggregated Narrative Comments 39

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Acknowledgements This work could not have been completed without the efforts of the consultants who assisted with different phases of the environmental scan: Gail MacKean Sharlene Wolbeck-Minke, SWM Consulting Birgitta Larsson, BIM Larsson & Associates Many thanks to those from the following programs who provided input to the project through early key informant interviews and/or pilot test of the draft Patient Safety Education Self-Assessment Tool: Division of Nursing, Saskatchewan Institute of Applied Science and Technology (SIAST) Faculty of Pharmacy, University of Saskatchewan University of Lethbridge and Lethbridge College – Nursing Education in Southwestern Alberta Program Medicine Hat College – Nursing Program, Therapist Assistant Program, Healthcare Aide Program

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Executive Summary Background The Blueprint Project aims to develop a framework for patient safety education in Alberta that will identify consistent key messages about patient safety based on a systems approach that should be incorporated into educational programs at all levels for all health care workers. It is not known to what extent healthcare provider education programs have embraced the systems approach to patient safety. This requires an attitudinal change and paradigm shift from the traditional model of individual provider responsibility for safe patient care that is taught in most undergraduate programs. Purpose The purpose of the environmental scan was to: • Determine the extent to which a systems approach to patient safety is integrated into

education programs for regulated health professions in Alberta’s post-secondary sector • Determine what kinds of resources would be helpful in supporting integration of a systems

approach to patient safety into post-secondary health disciplines curricula • Gather feedback about the utility and content of a draft Patient Safety Education Self-

Assessment Tool Method Based on a literature review, a draft Patient Safety Education Self-Assessment Tool (PSESAT) was developed to assist post-secondary healthcare provider education programs in determining to what extent a systems approach to patient safety has been integrated into their curriculum. The three themes explored through the tool items are:

1. Patient safety-related concepts taught in the program with a focus on a systems orientation to safety

2. Leadership and organizational factors that support a systems approach to patient safety 3. Responding to close calls and adverse events involving students

A guided self-assessment interview process based on the PSESAT was used to gather data for the environmental scan. Open-ended questions were added to gather respondents’ opinions on the importance and completeness of the tool items and their overall impression of the self-assessment process. Respondents were asked for suggestions about the kinds of resources that would help them incorporate a systems approach to patient safety into their curriculum. A sample of eighteen post-secondary education programs across Alberta were invited to participate in the environmental scan based on the following criteria: programs training regulated health professionals with representation from a broad scope of health disciplines, and representation from universities, technical institutes and colleges in both large and small urban centres. Because a single individual cannot know everything about how patient safety is integrated throughout the program’s curriculum, a team interview format was suggested, with

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representation if possible from a senior administrator, curriculum developer, classroom teacher and clinical teacher. During a telephone interview, the group was led through the PSESAT items and additional questions. The interviewer recorded the consensus score for each item on the self-assessment tool as well as discussion among respondents about each item and the open response questions. Key Findings Key findings are summarized according to the three objectives of the environmental scan. They are based on analysis of data provided by 60 respondents from the 18 post-secondary health disciplines programs who participated in the interviews. Groups typically consisted of three participants and the majority of interviews lasted between 90 and 140 minutes. Participants typically held multiple roles in their programs with most reporting that they are involved in classroom instruction.

Objective 1) Determine the extent to which a systems approach to patient safety is integrated into post-secondary health care provider education programs Overall, the scale ratings were high suggesting that patient safety is well-integrated into most programs, however it is not clear to what extent this reflects a systems oriented view of safety. Patient safety was of significant interest to participants and many commented that it is an integral component of their educational programs. However respondents often explicitly stated that they did not completely understand the terms or concepts related to a systems approach to patient safety that were embedded in the tool items. As a result, it appears that most respondents rated their programs based on their own perspective of what patient safety means. A disconnect between educational programs and clinical settings was evident which may hinder student practice of newly learned patient safety concepts. The programs clearly indicated they do not have control over the clinical setting and by extension, students’ experiences and learning related to patient safety that occurs there. Objective 2) Determine what kinds of resources post-secondary education programs for health care providers would find helpful in supporting integration of a systems approach to patient safety into their curricula. Programs expressed interest in user-friendly resources to help them learn about the concepts of a systems approach to patient safety. Most respondents recommended case studies, interactive technology-based resources and networking opportunities to learn from others who are successfully incorporating a systems orientation to patient safety into their programs. Objective 3) Gather feedback about the utility and content of the draft Patient Safety Education Self-Assessment Tool Respondents recognized that the process of completing the self-assessment tool may be its most important function. Critically reflecting on the tool items as a group raises awareness of a systems oriented approach to patient safety education and the components required for

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successful integration of this approach into a program. It helps programs move beyond an assumption that it is sufficient to teach students about their individual responsibility to provide safe patient care, to deeper reflection on other factors that can affect patient safety outcomes. Suggestions to improve the tool mainly concerned improving the clarity of wording and grammatical consistency, and developing a consistent rating scale applicable to all three themes. Providing definitions of terms, particularly those related to a systems approach to patient safety, will improve interpretation of tool items. Conclusion The feedback from eighteen diverse education programs that prepare healthcare professionals for practice suggest that while concepts related to safe patient care are an integral component of most programs, it appears that few programs are teaching a systems approach to patient safety. Programs would welcome user-friendly resources to help them learn about the concepts of a systems oriented approach to patient safety and how they apply across settings so that they could then incorporate these ideas into their teaching. With revisions, the Patient Safety Education Self-Assessment Tool will be a useful tool to stimulate thinking about how a systems approach to patient safety is taught in healthcare provider education programs.

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Background In the spring of 2009, the Health Quality Council of Alberta (HQCA) began a multi-year project (the “Blueprint Project”) to develop a framework for patient safety education in Alberta that will identify consistent key messages related to patient safety that should be incorporated into educational programs at all levels (undergraduate, post-graduate, workplace learning) for all health care workers (support staff, front-line care providers, managers, senior executives and board members). Major themes and learning topics for the framework have been identified based on the Healthcare Encounter Safety & Quality Model (Appendix 1) which presents an integrated systems-focused, principles-based view of patient safety that is centred on the healthcare encounter. Six principles provide a foundation for the model supporting the premise that safe healthcare requires:

• Patient engagement at all levels of healthcare delivery • Respectful, transparent relationships between and among those who deliver and those

who receive healthcare • Recognition that health workers function within complex systems to deliver care • A just and trusting culture • Appropriate responsibility / accountability at all levels of a healthcare system • Continuous learning and improvement

In May 2009 the project Steering Committee recommended that an environmental scan be undertaken to determine the extent to which a systems approach to patient safety is currently being addressed in undergraduate education programs for healthcare providers in Alberta. A literature scan was done to determine if there are promising practices in implementing patient safety and quality content into health sciences curriculum that should be reflected in the environmental scan questions. The literature suggested that effectively preparing new health care workers to practice with a systems view of patient safety requires more than presenting patient safety as a stand-alone topic (lecture or course) in the curriculum. Instead, a systems approach to patient safety is most effectively taught when integrated throughout a program’s curriculum with appropriate leadership and organizational supports in place, and should be reinforced by the way in which close calls and adverse events involving students are handled. It is not known to what extent healthcare provider education programs have embraced the systems approach to patient safety. This requires an attitudinal change and paradigm shift from the traditional model of individual provider responsibility for safe patient care that is taught in most undergraduate programs. Purpose The purpose of the environmental scan was to: • Determine the extent to which a systems approach to patient safety is integrated into

education programs for regulated health professions in Alberta’s post-secondary sector

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• Determine what kinds of resources post-secondary health disciplines programs would find helpful in supporting integration of a systems approach to patient safety into their curricula

• Gather feedback about the utility and content of a draft Patient Safety Education Self-Assessment Tool

Method 1. Patient Safety Education Self-Assessment Tool (PSESAT) Based on the literature review, a draft self-assessment tool (Appendix 2) was developed to assist post-secondary healthcare provider education programs in determining where they are at in the process of integrating a systems approach to patient safety into their curriculum. The three themes explored through the tool items are:

1. Patient safety-related concepts taught in the program with a focus on a systems orientation to safety

2. Leadership and organizational factors that support a systems approach to patient safety 3. Responding to close calls and adverse events involving students

Items for theme 1 were constructed based on the topics identified through the Healthcare Encounter Safety & Quality Model. Items for themes 2 and 3 were identified through the literature review. The draft tool was reviewed and pilot-tested for face validity by three post-secondary education programs familiar with a systems approach to patient safety and revised based on feedback received. The draft PSESAT was used in a guided self-assessment interview process (see below) to gather data for the environmental scan. Additional open-ended questions were added to the end of each section to gather respondents’ opinions on the importance and completeness of the tool items. Respondents also were asked for their overall impression of the process of completing the tool. Finally, they were asked for suggestions about the kinds of resources that would help them incorporate a systems approach to patient safety into their curriculum. 2. Sampling Strategy and Invitation to Participate Eighteen post-secondary education programs across Alberta (Table 1) were selected to be invited to participate in the environmental scan based on the following criteria:

• Focus on programs training regulated health professionals. Graduates of these programs are more likely to have significant responsibility for patient safety and quality improvement in their jobs.

• Representation from a broad scope of regulated health professions with an emphasis on engaging key stakeholders. Programs from the following disciplines were invited to participate (number invited/number of programs of that discipline in the province):

o Nursing: BN/RN – 6/10; LPN – 3/10 o Medicine – 2/2 o Pharmacy – 1/1

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o Rehabilitation medicine – 1/1 o Paramedic/EMT – 2/5 o Medical laboratory technology – 1/2 o Radiology technology – 1/2 o Respiratory therapy – 1/2

• Representation from universities, technical institutes and colleges. All universities (5) and technical institutes (2), and 5 of 11 colleges with health disciplines education programs in Alberta were represented in the initial sample.

• Representation from educational institutions in both large and small urban centres

Programs were approached by the HQCA to participate in the project. The initial e-mail request provided information about the Blueprint Project, environmental scan process and confidentiality (see Appendix 3). All invited programs agreed to participate. Table 1: Programs to be invited to participate in the environmental scan

University or College Program

University of Alberta Nursing (BN) Medicine Pharmacy Rehab (OT, PT, Speech)

University of Calgary Nursing (BN) Medicine

University of Lethbridge Nursing (BN) – shared program with Lethbridge College

Mount Royal University Nursing (BN)

Grant McEwan University Nursing (BN)

Red Deer College Practical Nurse (LPN)

Grand Prairie Regional College Nursing (BN) - collaborative degree program with U of A

Portage College (Lac La Biche) EMT-Paramedic

Northern Lakes College (Slave Lake)

Practical Nurse (LPN)

Lethbridge College Practice Nurse (LPN)

SAIT (Calgary) EMT-Paramedic Medical laboratory technology

NAIT (Edmonton) Medical radiologic technology Respiratory technology

3. Guided Self-assessment Interview Process Programs were asked to identify a contact person as well as a small group of individuals to participate in a telephone group interview based on the draft PSESAT. Because a single individual cannot know everything about how patient safety is integrated throughout the

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program’s curriculum, it was suggested that the interview team include if possible a senior administrator, curriculum developer, classroom teacher and clinical teacher. The PSESAT was sent to the contact person, who was encouraged to complete the self-assessment tool with their team prior to the group interview. During the interview, the group was led through the PSESAT items and additional questions. The consensus score for each item on the self-assessment tool was recorded. Discussion among respondents about how their program addressed that item and comments about the clarity of each item were also recorded. A transcription of the interview notes was returned to the program contact person after the interview to confirm the accuracy of the notes. Programs were encouraged to keep a copy of their completed self-assessment tool for future reference. 4. Data Analysis and Interpretation Both quantitative and qualitative methods were used in the analysis. The PSESAT items and responses to open-ended questions were used as an analytic template to guide data analysis. This facilitated a consistent analytic process between the two consultants who conducted the interviews. Tool Items Frequency distributions were calculated for each of the tool items. Since the responses on each item reflected the team’s consensus, the data were analyzed at the program level. Frequencies were not calculated across specified categories (i.e. college vs. university programs, health discipline, etc.) because the small sample size limited the generalizability of the results and made it difficult to maintain participant confidentiality. Scale Comments and Open-Ended Questions Narrative responses to scale items and open-ended questions were analyzed qualitatively with a constant comparison coding process (1,2,3). First, the data in each item were coded for initial themes. These initial themes were compared for similarities and differences, and the codes were refined to reflect a deeper understanding of patient safety education in the curricula, as well as tool feedback. The evaluators independently completed the initial coding and then reviewed each other’s work for consistency and completeness. There were no discrepancies in interpretation. Finally, they collaboratively reviewed each item across all three themes to ensure completeness and clarity in reporting.

Results

1. Description of Participating Programs Each of the 18 programs that were initially contacted about the environmental scan agreed to participate. A total of 60 people participated in 18 group interviews. The most common group size was three respondents with a range of one to five respondents per team. Most of the interviews were between 90 minutes and two hours long (range 50 to 140 minutes).

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Respondents reported holding multiple roles in their programs, with most being involved in classroom instruction. Only half of the respondents held an administrator role in their program (Figure 1). Figure 1: Respondents’ Roles in Program

2. Response to Items on the Patient Safety Education Self-Assessment Tool The frequency distribution of scale rankings (quantitative data) and aggregated narrative comments (qualitative data) for each item of the PSESAT are reported in Appendix 5. Paraphrased quotations from respondents’ comments are included in italics as appropriate. 3. Comments on the Self-Assessment Process How should the tool be used? Nearly all of the respondents perceived the tool to be valuable for facilitating deliberate consideration of how patient safety is addressed in the curriculum. A few programs believed it would be especially helpful in the curriculum development or planning stage. Some respondents noted that there should be more discussion or explanation of the purpose for completing the self-assessment. For example, is it intended to raise awareness, improve legislation, enhance curriculum development, or some other purpose? Many respondents suggested that a regular review with the tool would not be useful. Instead they believed that a periodic review every three or four years would help to ensure that the program is on track. Further, it was suggested that the tool might duplicate accreditation processes that already thoroughly cover patient safety issues.

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Who should complete the tool? Most respondents believed that a team or group with representation from across the program (i.e., administrators, managers, curriculum, classroom, and practicum) should complete the tool. For the most part, respondents recognized that no single person would have knowledge in all the areas required to complete the tool. A couple of programs suggested the tool also would be relevant to external clinical sites in order to raise their awareness of a collaborative approach to patient safety issues involving students. How should the group complete the tool? For the purposes of the environmental scan, it was suggested that respondents complete and discuss the tool as a group prior to the telephone group interview. In many of the programs, individual respondents completed the tool on their own then met as a group to discuss their answers and formulate a group response. In other cases, individuals completed the tool ahead of time but the group did not discuss their answers prior to the telephone interview. Most of the respondents reported that the tool could be completed in about 30 minutes. Group discussion of the responses required more time, typically about 45 to 60 minutes. Given that the group interviews also lasted about two hours, the participating programs invested a considerable amount of time in the environmental scan. 4. Comments on the Self-Assessment Tool Respondents provided feedback about the conceptual relevance of the tool, its clarity and in particular, the rating scales (Appendix 4). How relevant are the concepts covered in the tool to the programs? All of the respondents indicated that patient safety is integral to their curricula. For the most part, patient safety concepts are implicitly and/or explicitly included in all courses across different years of the program. A couple of programs reported that they have a module or course specifically focused on patient safety in their curricula, but noted that patient safety is still considered throughout the program. Some respondents commented that the tool content was not congruent with certain aspects of the program. This was particularly evident in programs where student practical experiences often occur in community or international settings. These programs reported, for example, that ‘close calls and adverse events’ are not terms used in community settings, but acknowledged that risks to patient safety still exist. It is worth noting that nearly every program reported some community settings where the tool was not directly applicable, as it was considered “acute-care centric”. Further, programs that do not routinely provide direct patient/client care found that many of the concepts and statements were not completely relevant. How clear is the tool? Overall, respondents stated that they understood and interpreted the tool items with little difficulty. The following areas for improvement were identified:

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• Improve the clarity of terms in tool. Respondents overwhelmingly called for definitions and examples of key terms. A possible format for the tool could be an electronic version with the information embedded as hyperlinks from highlighted text. Particularly problematic terms identified from discussion of tool items were:

o Systems-oriented approach to patient safety education o Patient o Fair and just o Just and trusting culture o Health literacy o Shared decision making o Standardized care protocols o Data o Close calls and adverse events

• Increase clarity of wording of some items (e.g. programs don’t purposefully seek “hazardous situations” for students – more clear wording could be “learn about or identify hazardous situations”; other terms open to interpretation include “explicit”, “expert”).

• Ensure that items are worded in a way that they can be answered using the rating scale. Some items as currently worded suggest a yes/no answer rather than a rating.

• Reword tool items to strengthen grammatical consistency and accuracy across the items. • Ensure the use of terms that are meaningful to the programs and accurately reflect the

context and reality of different health disciplines. Several programs indicated they do not use the term “patient”, but refer to “clients” or “residents”. Others commented that the tool seems to be very acute-care focused.

• Identify items that are potentially double-barreled and create separate questions (i.e., clinical instructors and clinical preceptors have different roles and should be in separate items).

How was the rating scale perceived? Applying the rating scale to some of the items proved difficult for most teams. In fact, many respondents provided suggestions for improving the scales. • Repeat the scale across the top of each page to make recording responses easier and more

accurate. • Create a consistent scale for all three themes to reduce confusion and potential for errors.

The reversal of the ranking structure between themes one and two was particularly problematic for respondents.

• A positive feature of the rating scales was that they acknowledged progressive movement towards integrating the concepts into a program, which helped respondents find the “right” rating. However the ranking scale in themes two and three was perceived by some respondents as too limited. The ranking system used in theme one was preferred.

• Ensure that the scale items are conceptually distinct to reduce variations in interpretation. Some respondents thought there was little distinction between the scale items in themes two and three (i.e., #2 planning underway and #3 plan in place were perceived as too similar).

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Similarly, depending on how respondents interpreted the ranking statements in theme one, they could potentially answer three responses (1a, 1b, and/or 2)

Key Findings by Objective Objective 1. Determine the extent to which a systems approach to patient safety is integrated into health care provider education programs in the post-secondary education sector in Alberta Patient safety appears to be well-integrated into most programs, but it is not clear to what extent this reflects a systems oriented view of safety. Overall, the scale ratings were high suggesting that patient safety is well-integrated into most programs. Respondents invested considerable time and human resources in the self-assessment process and overall the groups were engaged and committed to critical reflection on the integration of patient safety concepts into their curricula. Clearly, patient safety is of significant interest to them and many commented that it is an integral component of their educational programs. However discussion of the tool items by respondents revealed that when there was confusion about what a term or concept meant, they chose a rating for that item based their own interpretation of what each item meant, which was not necessarily congruent with a systems approach to patient safety. In fact, respondents often explicitly stated that they did not completely understand the terms or concepts related to a systems approach to patient safety that were embedded in the tool items. As a result, it appears that most respondents rated their programs based on their own perspective of what patient safety means. This acknowledged gap in understanding could explain the incongruity between the overall high scale ratings, which suggest a systems approach to patient safety is being taught, and considerable questioning and reflection about what each tool item meant. A disconnect between educational programs and clinical settings was evident. Post-secondary educational programs teach patient safety concepts, but students’ application of the concepts depends on their clinical experiences. The programs clearly indicated they do not have control over the clinical setting and by extension, students’ experiences and learning related to patient safety that occurs there. At times, respondents conveyed a sense of helplessness about student learning in the clinical setting being beyond their influence. This disconnect between the post-secondary institutions and clinical settings may hinder student practice of newly learned patient safety concepts. For example, many respondents interpreted the questions in Theme 1 within an ethics framework. There was a perception that students are taught “right and wrong” in theory, but do not always feel confident to speak up in clinical settings. Respondents recognized that improved continuity and communication between the educational program and clinical setting would enable students to practice what they learn, particularly with regard to a systems approach to patient safety. In addition, response to and

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discussion around items in Theme 3 on the tool (handling of close calls and adverse events involving students) clearly showed the lack of communication and collaboration between education programs and clinical settings regarding close calls and adverse events in which students may be involved. Objective 2. Determine what kinds of resources post-secondary education programs for health care providers would find helpful in supporting integration of a systems approach to patient safety into their curricula Programs want user-friendly resources to help them learn about the concepts of a systems oriented approach to patient safety Respondents suggested they could use resources that teach about concepts and terms integral to a systems oriented approach to patient safety. They noted that resources for students and faculty would “need clarity and overarching concepts that apply across settings”. Furthermore, the resources should be evidence-informed, user-friendly and make integration of the concepts easy by outlining “what are the key things we need to know” to ensure a systems approach in their teachings. Examples of user-friendly resources were easy-to-use tools and guidelines for how to incorporate the systems concepts/terms. Finally, respondents proposed that they would like to be able to access user-friendly resources through a central clearinghouse or “repository of tools, information”. Specific types of resources were recommended by respondents. The preferred type of resource is case studies that are rooted in real examples of a systems-oriented approach to patient safety across a variety of clinical contexts. Most respondents described the usefulness of interactive case studies that can be applied in a lab setting or that students can work through as a group. Respondents also expressed interest in interactive, technology-based resources. Overall, the internet was perceived as an accessible source of reliable information for faculty and students. Respondents specifically noted that links to credible websites on a systems oriented approach to patient safety would be especially valuable. Another interactive technology suggested was the online educational simulation which enables students to apply their learning to a specific situation created in a simulated or virtual world. Several respondents noted that students prefer web-based resources that can be accessed when it is convenient for the student. There was limited interest in traditional “teaching” materials. A few respondents, however, believed that written materials would be helpful, such as a “how-to binder”, worksheets for students, PowerPoint presentations, and readings/textbooks. They did not believe a standalone report on a systems-oriented approach to patient safety education would be helpful.

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Personal interaction to support learning about and incorporating a systems approach Respondents believed there is benefit in facilitating peer-learning among the post-secondary educational institutions. They would like information on how a systems approach to patient safety is incorporated in other programs and institutions, basically “who’s doing it, and how are they delivering material?” Development of an interdisciplinary network would help connect people and institutions who are integrating systems thinking about patient safety into their programs. Technology such as SharePoint® was suggested as a method for creating an interdisciplinary forum. Some teams suggested that in-person mentoring from experts in a systems-oriented approach to patient safety to support programs reviewing their curriculum and integrating concepts would be helpful. Examples included a traveling “road show”, building mentor relationships, and being able to access an external resource person. Influence regulators and accrediting organizations Finally, it was suggested that HQCA should work with the professions’ regulatory bodies and organizations that accredit post-secondary education programs to raise awareness of the systems-oriented approach to patient safety. Post-secondary programs develop their curricula to prepare graduates to meet entry-to-practice level standards set by the professions and to meet educational program accreditation requirements where they exist. If a systems approach to patient safety is required by one or both of these influential groups, then programs will strive to increase both their understanding of a systems-oriented approach and how this could be integrated into their curricula. Objective 3. Gather feedback about the utility and content of the draft Patient Safety Education Self-Assessment Tool Respondents recognized the value of the self-assessment process and the need to shift to a systems oriented view of patient safety. They provided ample feedback on the tool items (see Appendix 4 for specific comments on each item) with the intent of improving its utility. The process as the product Despite flaws in the draft PSESAT, respondents recognized that the process of completing the self-assessment tool may be its most important function. Critically reflecting on the items across the three themes in a group setting raises awareness of a systems oriented approach to patient safety education and the components required for successful integration of this approach into a program. The process of completing the tool also helps programs move beyond an assumption that it is sufficient to teach students about their individual responsibility to provide safe patient care, to deeper reflection on other factors that can affect patient outcomes and safety. Ultimately the tool is a vehicle for bringing the message about a systems view of safety to health disciplines education programs.

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Discussion The main goal of this project was to determine the extent to which a systems approach to patient safety is currently integrated into pre-professional education programs for regulated health professionals in Alberta. Healthcare provider education programs have an obligation to ensure that their graduates will be competent in activities they undertake to provide safe and effective care. Programs who participated in this project were clearly committed to this goal and many explicitly stated that patient safety is a priority that is integrated throughout the curriculum. However, increasingly it is recognized that individuals practice within systems that influence their ability to provide safe care for patients, and even the most competent practitioners can be involved in adverse events in which patients are harmed despite the best efforts of their care team. To create safe systems in which both patients and healthcare providers are protected from the consequences of adverse events, a paradigm shift in education is required. Students need to be taught not only how to practice competently, the traditional individual provider responsibility for safe patient care paradigm, but also how the system within which they work can affect their ability to provide safe care. The systems orientation to patient safety paradigm recognizes both the contribution of individuals and the system within which they work to ensuring patient safety. At the outset of the environmental scan project it was unclear to what extent the concept of a systems approach to patient safety was understood by educators in the post-secondary sector. In designing the tool items it was decided to deliberately word them to incorporate terminology reflecting a systems approach to patient safety, rather than trying to explain the concept in the wording of the tool item. Based only on scaled responses to tool items it appears that a systems approach to patient safety is well-entrenched in health disciplines education programs in Alberta. However, discussion among respondents about tool items revealed uncertainty about much of the terminology that was used, which suggests an incomplete understanding about the concept of a systems approach to patient safety and how it differs from what is currently being taught. Programs appeared to provide a rating for many tool items that was based on their interpretation of the concept of patient safety and how it is taught in their programs. While it is evident that many patient safety concepts are covered in most healthcare provider education programs, it is unlikely that a systems approach is being taught in most. Respondents recognized that they need more information about a systems approach to patient safety and how it differs from what they currently teach students. Programs identified that they could benefit most from user-friendly resources to help them learn about the concepts of a systems-oriented approach to patient safety and how they apply across settings so that they could then incorporate these ideas into their teaching. There is little interest in pre-packaged teaching materials other than case scenarios rooted in real examples of a systems-oriented approach to patient safety across a variety of clinical contexts that could be used to illustrate concepts.

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Despite limitations of the draft self-assessment tool (e.g. use of terminology that was not clearly understood by respondents, incorporating two concepts into some questions, rating scale that was difficult to apply, limited applicability of some topics to pre-professional education and training, unclear distinction between some items), it appears that the self-assessment process served an important purpose of stimulating discussion in participating programs about how concepts that support patient safety are integrated into the curriculum and what a systems approach to patient safety is. With some revisions, this could become a useful tool to stimulate thinking about how concepts supporting a systems approach to patient safety are integrated into healthcare provider curricula.

Conclusion The feedback from eighteen diverse education programs that prepare healthcare professionals for practice suggest that while many patient safety concepts are an integral component of most programs, it appears that few programs are teaching a systems approach to patient safety. Programs would welcome user-friendly resources to help them learn about the concepts of a systems oriented approach to patient safety and how they apply across settings so that they could then incorporate these ideas into their teaching. With revisions, the Patient Safety Education Self-Assessment Tool will be a useful tool to stimulate thinking about how a systems approach to patient safety is taught in health disciplines education programs.

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References 1. Bryson, A. (2004). Social research methods. New York, NY: Oxford 2. Creswell, J.W. (1998). Qualitative inquiry and research design: Choosing among five

traditions. Thousand Oaks, CA: Sage. 3. Strauss, A., & Corbin, J. (1990). Basics of qualitative analysis: Grounded theory procedures

and techniques. Newbury Park, CA: Sage.

Citation Wright D, Wolbeck-Minke S, Larsson B, Flemons W. Environmental scan of patient safety education in Alberta’s post-secondary education sector. Calgary: Health Quality Council of Alberta; 2010.

Copyright This document is licensed under a Creative Commons “Attribution-Noncommercial-No Derivative Works 2.5 Canada” license. For details see: http://creativecommons.org/licenses/by-nc-nd/2.5/ca/

Permission is granted to copy, distribute or transmit only unaltered copies of the document for non-commercial purposes. Please contact Dale Wright of the Health Quality Council of Alberta for more information at 403.355.4439 or [email protected].

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Appendix 1: The Healthcare Encounter Safety & Quality Model The Healthcare Encounter Safety & Quality Model is centered on the healthcare encounter – a representation of the provision of healthcare, in which the people/teams providing healthcare (in association with the organizations/regulatory/funding agencies that provide infrastructure) interact with the recipients of healthcare - patients, their families and/or supporters, the broader community and populations, as well as society.1 The model places the healthcare encounter in the context of three broad objectives: keeping people healthy, diagnosing and/or treating conditions when they arise, and providing care at the end of life. This triad of objectives was adapted from the Health Quality Council of Alberta’s Quality Matrix.2

Embedded within the model is a human factors based approach, described by Davies,3.4 for understanding why failures of healthcare delivery occur. The approach is based on Donabedian’s triad of structure, process, and outcome,5 as well as an adaptation of Reason’s model of the dynamics of accident causation6,7 and Helmreich’s concept of simultaneously operating factors that influence behaviour.8

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The model highlights the critical importance that interaction between providers and recipients involved in the healthcare encounter plays in the safe, effective, and efficient delivery of healthcare. It reflects three key functions that the healthcare system must continually perform to improve the safety and quality of care delivered to patients:

1. design of healthcare encounters for populations/communities of patients to ensure the reliable delivery of optimal (evidence-based) care 2. delivery of optimal care to individual patients 3. response to patients by managing events when the delivery of healthcare and the outcomes of that care are not optimal.

The HES&Q model also highlights two foundational elements that healthcare systems require to support the stakeholders and the key healthcare system functions: 1. leadership (that must occur at all levels of the healthcare system) 2. principles of patient safety and quality Although the model was designed to support patient safety education, it could also be used to support an organization’s strategic vision for improving the quality and safety of healthcare delivered to its patients. References 1. Patient Safety Curriculum Project Working Group (University of Calgary and Alberta Health

Services – Calgary Zone, Calgary, AB). The Patient Safety Curriculum Project: Defining a comprehensive educational framework. Calgary (AB): March 2009. 14 p. Report of an invitational symposium held in November 2008.

2. Health Quality Council of Alberta. Alberta Quality Matrix for Health [Internet]. Calgary: Health Quality Council of Alberta; 2004. Available from: http://www.hqca.ca/assets/pdf/Matrix%20.pdf (accessed March 2010).

3. Davies JM. Application of the Winnipeg model to obstetric and neonatal audit. Top Health Inf Manage. 2000;20:12-22. 4. Davies JM, Lange IR. Investigating adverse outcomes in obstetrics. J Obstet Gynaecol Can. 2003;25:505-15. 5. Donabedian A. Team communication in the operating room. Milbank Mem Fund Q.

1966;44:166-206. 6. Reason J. The contribution of latent human failures to the breakdown of complex systems.

Phil Trans R Soc Lon B 1990;327:475-84. 7. Reason J. Human error. Cambridge: Cambridge University Press; 1990. 8. Helmreich R. Human factors aspects of the Air Ontario crash at Dryden, Ontario: analysis and recommendations to the Commission of Inquiry into the Air Ontario crash at Dryden, Ontario.

In: Moshansky VP, The Honourable (Commissioner). Commission of Inquiry into the Air Ontario Crash at Dryden, Ontario: Final Report. Technical Appendices. Ottawa: Ministry of Supply and Services Canada; 1992.

22

Appendix 2: Draft Patient Safety Education Self-Assessment Tool Introduction This tool has been developed by the HQCA in collaboration with educators across Alberta for two reasons:

1) To assist post-secondary health care provider education programs in assessing where they are at in the process of integrating a systems-oriented approach to patient safety into their curriculum.

2) To provide a means for collecting aggregate data on how the integration of a systems-oriented approach to patient safety is progressing across post-secondary education programs in Alberta.

Education programs involved in piloting this self-assessment tool told us that going through this tool would benefit their programs, both because of the educational nature of the tool and the process of bringing people together to discuss and answer the questions.

In a systems-oriented approach, when patient safety is compromised the primary focus for improvement is on how to improve the system factors that contributed to the adverse event, not on how to improve individual care providers. The systems view of patient safety recognizes that while individual health care providers have a responsibility to provide safe patient care, many risks to patients (and therefore the greatest opportunities to improve safety) are related to the systems of care within which individuals work. This is evident in the majority of adverse events where the answer to the question: “Could someone else have made this same error?” is yes, meaning that it is probably a systems issue(s) that needs to be addressed to prevent the error from happening again.

This self-assessment tool is divided into three broad sections:

1) Patient safety-related concepts taught in the program 2) Leadership and organizational factors that support a systems-oriented approach to

patient safety within an education program 3) Responding to close calls and adverse events involving students

These three sections, and the promising practice statements included within each, were identified through a literature review and discussions with leaders in the field. Because a systems-oriented approach to patient safety is a relatively new approach, these practices may not yet be widely implemented. However many administrators, faculty and/or clinical teachers may have begun to think about or are actively beginning to integrate a systems-oriented approach to patient safety into their education programs.

Who should complete this self-assessment tool? Because there is no one person who knows everything about how patient safety is taught in a given program, it is best that this tool be completed by a team consisting of at least:

• An administrator or manager in the program • Someone responsible for curriculum development in the program • Someone who teaches in the “classroom” (clinical content, not basic sciences)

23

• Someone who precepts students in clinical learning activities (if possible)

The value in a self-assessment process typically lies in the discussion that takes place around the questions and it is useful to bring a number of different perspectives to the table.

Theme 1. Patient safety-related concepts taught in the program Education that promotes a systems-oriented approach to patient safety will include content related to patient safety principles, design and implementation of safe systems, delivery of safe care, and responding when things go wrong. The following concepts have been identified as important to developing a systems-oriented approach to patient safety in post-secondary education programs that prepare health care providers for practice.

The rating scale for this section acknowledges that these concepts may be taught explicitly as an identified learning topic or implicitly, embedded in a related topic. For concepts that are taught explicitly, a distinction is made between learning about something conceptually (theory and principles), and skill development to enable transfer of theory and principles into practice.

Rating Scale: 1 - We include his concept explicitly as an identified learning topic a) – we teach theory and principles related to this concept b) – we provide opportunities for students to develop the necessary skills 2 – We include this concept implicitly as part of another topic 3 – We do not include this concept 4 – Don’t know/need more information about this concept to decide Check as many as apply:

Theme 1: Patient safety-related concepts taught in the program

Current status Item #

1a

1b

2 3 4

1 Principles of health literacy (patient knowledge of and ability to understand and use health information) as a strategy for improving communication with patients and families

2 Shared decision making with patients

3 The role of evidence-informed standardized care protocols in delivering optimal care

4 Working effectively in an inter-disciplinary team for the provision of safe patient care

5 Responsibility of all team members, including students, to let other team members know about of concerns they have about a patient’s safety

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6 Hazards and hazardous situations that can affect patient safety

7 Responsibility to intervene in situations where a patient’s safety could be compromised

8 Reporting systems for close calls and adverse events

9 Communicating information about close calls and adverse events to patients and others

10 Support mechanisms for those involved in an adverse event, including patients and healthcare providers

11 Principles and practices of a just and trusting culture

12 The contribution of both system and individual factors to occurrence of adverse events

13 Methods of investigating system factors contributing to an adverse event

14 How to use learning from adverse events to influence change in systems that support delivery of safe and effective care

15 Quality improvement methods to support delivery of safe and effective care (e.g., PDSA, Six Sigma, Lean)

16 The role of data to improve systems and support delivery of safe and effective care

17 Change management strategies to improve systems and support delivery of safe and effective care

Total:

Specify any other patient safety concepts included in your program that are not listed above and rate them using the same scale

Do you offer a specific course or module in your program that is focused on the topic of patient safety and/or quality improvement? Yes No If yes, what is it/are they called? Would you be willing to share it/them with others? Yes No

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Theme 2. Leadership and organizational factors that support a systems-oriented approach to patient safety The following statements represent promising practices that can help ensure that a systems-oriented approach to patient safety is integrated into post-secondary education programs for healthcare providers.

The rating scale for this section acknowledges that programs may be in various stages of implementation of these practices. Because a systems-oriented approach to patient safety is a relatively new concept, it is expected that many programs will be in the very early stages of integrating a systems-oriented approach into their programs.

Rating Scale (Select only one): 1 = Not doing anything in this area at the moment (i.e. aware but no action taken) 2 = Starting to consider this (i.e., information gathering and/or discussion/planning underway) 3 = In the process of implementing (i.e., plan in place and taking some action) 4 = Implemented or integrated into the program (i.e. doing this in our program) 5 = Don’t know/need more information to decide Theme 2: Leadership and organizational factors that support a systems-oriented approach to patient safety

Implementation Status

Item #

1 2 3 4 5

1 A clear distinction is made between a systems-oriented approach to patient safety and an individual practitioner responsibility for safe patient care.

2 Patient safety is included as an explicit priority in the education program

3 A senior administrative leader in the program demonstrates vision and commitment to a systems-oriented approach to patient safety and quality.

4 The program has faculty member(s) with recognized expertise in patient safety and/or quality who can serve as role models and thought leaders.

5 Faculty members participate in faculty development programs related to a systems-oriented approach to patient safety and quality.

6 Patient safety is viewed as a concept that should be integrated across the curriculum rather than taught as a stand-alone topic

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7 As the curriculum is being reviewed, consideration is given to how patient safety-related concepts and content can be integrated into the curriculum.

8 A flexible curriculum development process allows curriculum to be adapted or updated in a timely way in response to important developments in healthcare practice such as patient safety.

9 Partnerships or collaborations are established with other health care provider education programs to support interdisciplinary education.

10 Interdisciplinary learning opportunities are included in the program to prepare students to work effectively in teams.

11 Learning opportunities are included in the program to prepare students to work collaboratively with patients and families.

12 Clinical teachers who mentor students during their practical learning experiences are expected to have knowledge of the systems approach to patient safety and quality.

Total:

Specify any other leadership or organizational factors, that support a systems-oriented approach to patient safety in your program, that not listed above

Theme 3. Responding to close calls and adverse events involving students Administrators of educational programs are encouraged to review their policies and practices related to handling of adverse events and close calls involving students during clinical/practical learning experiences to ensure that a systems-oriented approach to patient safety is modeled. The following statements represent promising practices in this area.

The rating scale for this section acknowledges that programs may be in various stages of implementation of these practices. Because a systems-oriented approach to patient safety is a relatively new concept, it is expected that many programs will be in the very early stages of integrating a systems-oriented approach into their programs.

Rating Scale (Select only one): 1 = Not doing anything in this area at the moment (i.e., may be aware but no action taken) 2 = Starting to consider this (i.e., information gathering and/or discussion/planning underway) 3 = In the process of implementing (i.e., plan in place and taking some action) 4 = Implemented or integrated into the program (i.e. doing this in our program) 5 = Don’t know/need more information to decide

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Theme 3: Responding to close calls and adverse events involving students

Implementation Status

Item #

1 2 3 4 5

1 There is a process in place to review close calls and adverse events in which students are involved during clinical/practical learning experiences, in order to determine the contribution of both system-related factors (health system and education program) and student factors.

2 There is a process for remediation (e.g., clinical learning contract; clinical or performance improvement plan) when review of a close call or adverse event suggests that there is/are significant student performance issue(s) that contributed to the event.

3 Information obtained through these processes is aggregated in a way that protects anonymity, and is used to identify opportunities to improve the education program.

4 A reporting system is in place to gather information about close calls and/or adverse events in which students are involved while they are in practice/clinical learning situations

5 The student data collected through any incident reporting system in place in the clinical practice setting (5 above) is routinely shared with the education program, and used to identify opportunities to improve the education program.

6 A fair and just process is in place to support students who are involved in an adverse event during a clinical/practical learning experience.

7 A fair and just process is in place to support clinical instructors/preceptors who are involved in an adverse event with a student during a clinical/practical learning experience.

8 Appropriate emotional support is provided to both students and their clinical instructors/preceptors who are involved in adverse events that result in patient harm to help them cope with the situation.

Total:

Specify any other of your program processes, related to responding to close calls and adverse events involving students, that are not listed above

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Appendix 3: Information Provided to Participants About the Environmental Scan

1) Information for Participants Provided with the Initial Contact

Information for Participants: Environmental Scan of Patient Safety Education in the

Post-Secondary Sector in Alberta Background The environmental scan is being undertaken as part of the Blueprint for Patient Safety Education in Alberta Project. This is a collaborative project sponsored by the Health Quality Council of Alberta (HQCA) that is intended to identify key consistent messages related to patient safety that can be incorporated into educational programs at all levels (undergraduate, post-graduate, workplace) for all healthcare workers (support staff, frontline providers, managers, senior executives and Board members). What is the purpose of this project? The purpose of the environmental scan is to:

• Determine the extent to which a systems approach to patient safety is integrated into health care provider education programs in the post-secondary education sector in Alberta

• Determine what kinds of resources post-secondary education programs for health care providers would find helpful in supporting integration of a systems approach to patient safety into their curricula

• Gather feedback about the utility and content of the draft Patient Safety Education Self-Assessment Tool

What are you being asked to do? You are being asked to participate in a group interview along with some of your colleagues to discuss how a systems approach to patient safety is integrated into your program. This interview is expected to take no more than two hours. What are the risks? We do not foresee any significant risks to individuals or programs as a result of participating in the interview. Comments collected during the interview will not be attributed to an individual or program, and no questions of a personal nature about individuals will be asked. Data collected from all participating programs will be presented in a way that neither individuals nor programs can be identified. How will you benefit from taking part? As a participant in the project, you will have a chance to learn about ways to improve the way future health care providers can be taught about patient safety. Information from the environmental scan will be used to help the project team understand challenges faced by the post-secondary sector in this area and identify the kinds of resources needed to improve the way patient safety content is integrated into curricula. In addition, it will assist us in developing a self-assessment tool that programs can use to assess their progress in integrating a systems approach to patient safety into their curricula.

29

Is participation voluntary? You and your program are free to accept or decline the request to participate in the interview. What else does participation involve? One two-hour group interview and an opportunity to review notes from the interview to ensure the views of you and your colleagues are accurately represented. Is there payment for participating? No. Programs will not be paid for participating in the project and do not have to pay to be involved. How will privacy be protected? We will not collect any personally identifying information about interview participants. We will keep identifying information about the program in a separate place from the interview data and refer to the data for your program only by code. Subgroup analysis will be limited to a group size of at least three to maintain anonymity of program-specific data. Who will have access to the data? Only the two evaluators who are hired to conduct the interviews and data analysis will have access to program-specific data. Data will be aggregated and de-identified for presentation to the project team, HQCA staff and Blueprint Project committees and working groups. How will the results be shared? A report summarizing the findings of the environmental scan will be shared with Blueprint Project team members, committees, and participating programs. Information related to the scan may be shared through poster presentations or publications describing the Blueprint Project.

30

2) HQCA Follow-Up to Expression of Interest from Invited Programs Hello (Contact Name), Thanks for your prompt response to our invitation to participate in the environmental scan of how patient safety (not health care provider safety) is being integrated into health care provider education programs in Alberta’s post-secondary sector. The environmental scan involves a telephone interview of no more than 2 hours with a group or 3 or 4 people from your program. We ask each program to: • Identify a primary contact person in the program who will work with us to coordinate the

interview at your site. This person will also distribute the interviewer’s notes to the team post-interview and collate feedback about the notes to the interviewer.

• Identify 3 or 4 people to participate in the interview. Because no single individual knows everything about how patient safety is integrated throughout the curriculum, we suggest that individuals representing the following points of view be invited to join the interview “team”: o Someone with senior administrative responsibilities in the program o Someone involved in curriculum development or planning o An instructor o If possible, someone who precepts students in the clinical environment – we

acknowledge that this will be difficult or impossible for some programs o

HQCA has hired two evaluators (Sharlene Wolbeck Minke and Birgitta Larsen) to conduct the interview and data analysis in order to keep program responses confidential. The name and contact information for your primary contact will be sent to our evaluators and they will contact you to give you more information about the interview process once we have set up an interview time. I will get back to you soon with some suggested interview times. In the meantime it would be very helpful if you could let me know who the primary contact for your program will be. You can also start thinking about which colleagues and staff in your program could be invited to participate as part of the interview team. We look forward to working with you on this important project. (Ms) Dale Wright Project Co-Chair – Blueprint for Patient Safety in Education in Alberta Project

31

3) Consultant Correspondence - Appointments Scheduled and Key Contacts Identified Hello (Contact Name), Thank you for agreeing to organize your institution’s participation in the HQCA environmental scan of integrating patient safety into post-secondary education programs. How many will participate in the interview? I have attached the self assessment tool that we will focus our discussion on. In order to prepare for our discussion, please meet with the interview team (the colleagues that you have identified) to review and discuss the self-assessment tool prior to the interview. Team members should have their copy of the completed self-assessment tool available during our interview on (Interview Date) so we can discuss the responses. I suggest that each team member join the call from their own phone. I will forward the conference number in a separate email. OR Please confirm that you have received the conference number. I also suggest that you record your program's final responses to the self-assessment tool during the interview and keep the copy after the discussion. That way you can compare your responses with the aggregated data in the HQCA's final report. In addition to completing the self assessment tool we ask you to consider the following questions after each of the three sections: • Are all these questions important? • Are there important questions missing? • Once we have reviewed the self assessment tool we will also be asking you: • Based on your experience completing this tool, who would be the most suitable person to

use the tool? • Based on your experience completing the tool - how long does it take to complete the self

assessment tool? • Do you see yourself using this tool in the future? (is it of value to you?) Please let me know if you have any questions about preparation for the interview. Thanks, Sharlene/Birgitta

32

Appendix 4: Feedback on Patient Safety Education Self-Assessment Tool Theme 1: Patient safety-related concepts taught in the program

Tool Item Feedback on Tool Item

1. Principles of health literacy (patient knowledge of and ability to understand and use health information) as a strategy for improving communication with patients and families

Need definition of term ‘health literacy’; unsure of meaning

Unclear about how broadly/narrowly to interpret question (i.e., focusing on actual terms used with patient or how the student relates/discusses with patient?)

Need to consider across entire curricula – need group discussion in order to get perspectives of different years, courses in program – to determine if principles are used as a strategy

2. Shared decision making with patients

When selecting rating, how much of curriculum to consider (i.e., core program courses vs. mandatory electives)

3. The role of evidence-informed standardized care protocols in delivering optimal care

Issues with terminology:

What is a standardized protocol – clinical practice guidelines, care map?

Self-defined as “knowing the standard for treating a patient”

Seemed to interpret question as having 2 parts to consider: 1) evidence informed and 2) standardized protocol

Half suggest that evidence-informed should be mentioned distinct from standardized protocols.

i.e., Evidence is implicit in protocols, “teach evidence-based practice”

Uncertainty about how to interpret terms – is care protocol the same a care map?

Could increase clarity by providing examples for interpreting

4. Working effectively in an inter-disciplinary team for the provision of safe patient care

1a) on scale interpreted as a specific theory on interdisciplinary work – respondent wondered what theory this is

Two aspects to the question: 1) interdisciplinary team and 2) safe patient care

Does safe patient care = best care?

33


5. Responsibility of all team members, including students, to let other team members know about of concerns they have about a patient’s safety

Unclear about scale – does explicit subsume implicit?

“the question is grammatically incorrect” [Note: This comment probably refers to “about of” in question statement]

Terminology – alerting others to possible harm is part of professional role, but don’t call this safety

6. Hazards and hazardous situations that can affect patient safety

Unclear about scale – does explicit subsume implicit?

Unclear about meaning of “hazards” – unsafe practice environment? Exposure to hazardous materials?

Suggest changing wording to “learning about or identifying hazards” because don’t purposefully seek hazards for students to experience

7. Responsibility to intervene in situations where a patient’s safety could be compromised

Question is very close to #5

Unclear about meaning of responsibility – students taught to intervene if a medication error occurs, but is this the focus?

8. Reporting systems for close calls and adverse events

Need terms more widely used in diverse practice settings (i.e., Many community partners don’t use “adverse events” and “close calls”)

Increase clarity about reporting in question (reporting to whom?)

9. Communicating information about close calls and adverse events to patients and others

Need clarity on who is “others” – family members? Interdisciplinary team members?

Two concepts in single question (close calls AND adverse events) makes it difficult to interpret

Question is applicable to direct patient care – but what if field is not involved in direct patient care?

10. Support mechanisms for those involved in an adverse event, including patients and healthcare providers

Question needs more clarity – support for whom? Formal vs. informal?

Question links with Theme 3

11. Principles and practices of a just and trusting culture

Overall, unclear about meaning of just and trusting (therefore multiple interpretations)

34


12. The contribution of both system and individual factors to occurrence of adverse events

Don’t know what is meant by system and individual factors, don’t understand questions, don’t understand system approach

Need separate questions for system and individual

13. Methods of investigating system factors contributing to an adverse event

Unsure how this would work, what are methods of investigating?

Need definition of “methods of investigating” – does this mean root cause analysis?

14. How to use learning from adverse events to influence change in systems that support delivery of safe and effective care

Language reflects acute care context – “adverse events” not a common term in community or international settings

Need more information on the topic to answer question

15. Quality improvement methods to support delivery of safe and effective care (e.g., PDSA, Six Sigma, Lean)

Not familiar with the examples of QI methods

Inclusion of QI concepts varies across program area (courses and junior vs. senior level class)

16. The role of data to improve systems and support delivery of safe and effective care

The term “data” is vague – interpreted in different ways or not at all (i.e., not sure what it means)

17. Change management strategies to improve systems and support delivery of safe and effective care

Question is broad – quite open to different interpretations

Theme 2: Leadership and organizational factors that support a systems-oriented approach to patient safety


1. A clear distinction is made between a systems-oriented approach to patient safety and an individual practitioner responsibility for safe patient care

Request clarity on what is leaders’ role with regard to distinction

Definition of terms (individual practitioner responsibility vs. systems approach) would help with interpretation of question

Difficulties with scale– little distinction between ratings; preferred scale in theme 1

35


2. Patient safety is included as an explicit priority in the education program

The word “explicit” makes question difficult to interpret.

Could interpret this to mean patient safety is a course objective or integrated throughout the program.

3. A senior administrative leader in the program demonstrates vision and commitment to a systems-oriented approach to patient safety and quality

Need definition of systems approach in order to answer question

Too many components in question to answer with single response

4. The program has faculty member(s) with recognized expertise in patient safety and/or quality who can serve as role models and thought leaders

Participants unanimous that need more clarity with terms:

Recognized – by whom?

Expertise – what qualifications or credentials?

Thought leader – ‘is this limited to only leaders who think?’

Faculty member – sessional, clinical educators

Role model (for whom – students, faculty?)

5. Faculty members participate in faculty development programs related to a systems-oriented approach to patient safety and quality

All unsure exactly what question is asking

“Faculty development program” perceived as unclear or not applicable to educational program (a health organization process)

6. Patient safety is viewed as a concept that should be integrated across the curriculum rather than taught as a stand-alone topic

Difficult to answer question with scale – reads as an agree/disagree statement

7. As the curriculum is being reviewed, consideration is given to how patient safety-related concepts and content can be integrated into the curriculum

Need to increase clarity - is this question explicitly asking if patient safety is taught across the curriculum?

36


8. A flexible curriculum development process allows curriculum to be adapted or updated in a timely way in response to important developments in healthcare practice such as patient safety

Problem terms:

Timely – what is timely?

Flexible – does this mean academic freedom?

Development – or updating?

Key is how question is interpreted in context of program – changes in clinical or class curriculum?

Reads like an agree/disagree statement

9. Partnerships or collaborations are established with other health care provider education programs to support interdisciplinary education

Clarify scope of partnerships and interdisciplinary collaboration

(i.e., Is this referring to an interdisciplinary approach for students or is it for other partnerships as well?)

10. Interdisciplinary learning opportunities are included in the program to prepare students to work effectively in teams

No comments

11. Learning opportunities are included in the program to prepare students to work collaboratively with patients and families

No comments

12. Clinical teachers who mentor students during their practical learning experiences are expected to have knowledge of the systems approach to patient safety and quality

Question has too many elements to respond to – systems approach, patient safety and quality should be distinct

Again, need definition of systems approach

2 parts to question: 1) expectations of clinical teachers, and 2) how expectations are supported

Variety of terms used for clinical teacher: preceptor, clinical teacher, sessional, instructors, health care providers, faculty

37

Theme 3: Responding to close calls and adverse events involving students

Tool Items Feedback on Tool Item

1. There is a process in place to review close calls and adverse events in which students are involved during clinical/practical learning experiences, in order to determine the contribution of both system-related factors (health system and education program) and student factors

Is the item focusing on internal processes or through the student life and placement?

Also difference between close call and adverse events.

2. There is a process for remediation (e.g., clinical learning contract; clinical or performance improvement plan) when review of a close call or adverse event suggests that there is/are significant student performance issue(s) that contributed to the event

No respondents to this item

3. Information obtained through these processes is aggregated in a way that protects anonymity, and is used to identify opportunities to improve the education program

This is a two-stepped approach to using data. Respondents may comply with one and not the other.

4. A reporting system is in place to gather information about close calls and/or adverse events in which students are involved while they are in practice/clinical learning situations

Adverse event and close calls are two different things and can be handled differently.

There are two ways of interpreting this:

1) Incident reports

2) A reporting system in place in the institutional setting using this information.

Who’s system is the item focusing on? Does it matter?

Several respondents can’t see the difference between item 1 and this item.

38

Tool Items Feedback on Tool Item

5. The student data collected through any incident reporting system in place in the clinical practice setting (5 above) is routinely shared with the education program, and used to identify opportunities to improve the education program

As can be expected based on item 4 – there is very low compliance with this item.

The reference is incorrect (5 above.)

6. A fair and just process is in place to support students who are involved in an adverse event during a clinical/practical learning experience

Does this relate to the educational institution or the clinical setting?

7. A fair and just process is in place to support clinical instructors/preceptors who are involved in an adverse event with a student during a clinical/practical learning experience

Clinical instructors and preceptors are 2 different groups – should not be in same item.

8. Appropriate emotional support is provided to both students and their clinical instructors/preceptors who are involved in adverse events that result in patient harm to help them cope with the situation

What is appropriate?

Preceptor and clinical instructors have different relationship with the educational institution.

Should be split into two items – student and clinical instructor.

39

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Dis

trib

uti

on

o

f S

ca

le R

es

po

ns

es

T

oo

l It

em

1a

1

b

2

3

4

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

2.

Sh

are

d d

ec

isio

n

ma

kin

g w

ith

p

ati

en

ts

15

1

7

1

0

0

Mo

st p

rog

ram

s b

elie

ve t

he

y co

ver

sha

red

de

cisi

on

ma

kin

g w

ith p

atie

nts

in t

he

ir

curr

icu

lum

. A

ga

in,

the

de

scri

ptio

ns

of

the

co

nce

pt

see

me

d t

o v

ary

acr

oss

th

e

resp

on

de

nts

to

th

is q

ue

stio

n:

• S

ha

red

de

cisi

on

ma

kin

g o

ccu

rs w

ithin

go

al s

ett

ing

•

Sh

are

d d

eci

sio

n m

aki

ng

occ

urs

with

in in

form

ed

co

nse

nt

•

Sh

are

d d

eci

sio

n m

aki

ng

occ

urs

with

in c

om

mu

nic

atio

n

3.

Th

e r

ole

of

ev

ide

nc

e-i

nfo

rme

d

sta

nd

ard

ize

d c

are

p

roto

co

ls i

n

de

liv

eri

ng

op

tim

al

ca

re

13

1

3

3

1

1

Th

e r

esp

on

de

nts

to

th

is q

ue

stio

n t

en

de

d t

o f

ocu

s th

eir

an

swe

r o

n e

ithe

r th

e r

ole

of

evi

de

nce

or

the

use

of

pro

toco

ls in

th

eir

pro

gra

m.

Fe

w r

efle

cte

d o

n b

oth

ele

me

nts

.

Ha

lf o

f th

e p

rog

ram

s th

at

resp

on

de

d t

o t

his

qu

est

ion

re

po

rt t

ha

t th

ey

cove

r p

roto

cols

in

the

ir c

urr

icu

lum

, b

ut

the

typ

e o

r u

nd

ers

tan

din

g o

f “p

roto

col”

va

rie

s. E

xam

ple

s o

f st

an

da

rdiz

ed

pro

toco

ls in

clu

de

d c

are

ma

ps

an

d c

linic

al p

ract

ice

gu

ide

line

s.

Alth

ou

gh

less

th

an

ha

lf e

mp

ha

size

d t

he

imp

ort

an

ce o

f e

vid

en

ce-i

nfo

rme

d b

est

pra

ctic

e

in r

esp

on

din

g t

o q

ue

stio

n,

the

re w

as

a s

tro

ng

er

em

ph

asi

s o

n t

he

use

of

evi

de

nce

th

an

st

an

da

rdiz

ed

pro

toco

ls.

4.

Wo

rkin

g

eff

ec

tiv

ely

in

an

in

ter-

dis

cip

lin

ary

te

am

fo

r th

e

pro

vis

ion

of

sa

fe

pa

tie

nt

ca

re

15

1

7

1

0

0

Ab

ou

t h

alf

of

the

re

spo

nd

en

ts t

o t

his

qu

est

ion

inte

rpre

ted

inte

rdis

cip

lina

ry t

o m

ea

n

tea

m w

ork

an

d n

ote

d t

ha

t it

is a

str

on

g c

om

po

ne

nt

of

the

ir p

rog

ram

’s c

ou

rse

wo

rk

an

d/o

r cl

inic

al.

A c

ou

ple

of

resp

on

de

nts

no

ted

th

at

alth

ou

gh

th

e c

ove

r in

terd

isci

plin

ary

te

am

wo

rk in

th

eir

cu

rric

ulu

m,

the

ir t

ea

chin

g t

ea

m is

no

t in

terd

isci

plin

ary

.

So

me

als

o n

ote

d t

ha

t th

ere

is a

diff

ere

nce

be

twe

en

pa

rtic

ipa

ting

on

an

inte

rdis

cip

lina

ry

tea

m a

nd

te

ach

ing

ab

ou

t in

terd

isci

plin

ary

ap

pro

ach

es.

In

fa

ct,

it se

em

s th

at

inte

rdis

cip

lina

ry o

pp

ort

un

itie

s in

clin

ica

l se

ttin

gs

can

be

lim

ited

by

fact

ors

be

yon

d

pro

gra

m’s

co

ntr

ol,

such

as

the

ge

og

rap

hic

loca

tion

of

sch

oo

l.

41

Fre

qu

en

cy

Dis

trib

uti

on

o

f S

ca

le R

es

po

ns

es

T

oo

l It

em

1a

1

b

2

3

4

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

5.

Re

sp

on

sib

ilit

y o

f a

ll t

ea

m m

em

be

rs,

inc

lud

ing

stu

de

nts

, to

le

t o

the

r te

am

m

em

be

rs k

no

w

ab

ou

t o

f c

on

ce

rns

th

ey

ha

ve

ab

ou

t a

p

ati

en

t’s

sa

fety

13

1

3

5

0

0

Th

e m

ajo

rity

of

resp

on

de

nts

to

th

is it

em

ind

ica

ted

th

at

the

ir p

rog

ram

s im

plic

itly

cove

r th

e c

on

cep

t o

f le

ttin

g o

the

r te

am

me

mb

ers

kn

ow

ab

ou

t p

atie

nt

safe

ty c

on

cern

s. I

t m

ay

be

inco

rpo

rate

d in

clin

ica

l eva

lua

tion

to

ols

, in

clu

de

d in

dis

cuss

ion

s o

f p

rofe

ssio

na

l ro

les

or

pre

sen

ted

as

an

eth

ica

l re

spo

nsi

bili

ty.

Ve

ry r

are

ly,

ho

we

ver,

do

th

e p

rog

ram

s id

en

tify

this

exp

licitl

y a

s “p

atie

nt

safe

ty”

in t

he

ir c

urr

icu

lum

.

6.

Ha

zard

s a

nd

h

aza

rdo

us

s

itu

ati

on

s t

ha

t c

an

a

ffe

ct

pa

tie

nt

sa

fety

18

1

6

0

0

0

Th

e m

ajo

rity

of

pro

gra

ms

tha

t e

lab

ora

ted

on

th

is it

em

exp

licitl

y in

clu

de

d h

aza

rds

in t

he

ir

curr

icu

lum

. T

he

exa

mp

les

pro

vid

ed

fo

cus

on

diff

ere

nt

typ

es

of

ha

zard

s a

nd

ho

w

ind

ivid

ua

ls c

an

ide

ntif

y a

nd

pre

ven

t ri

sks,

su

ch a

s fir

e s

afe

ty t

rain

ing

, m

ed

ica

tion

h

aza

rds,

pa

tien

t b

ed

ra

il sa

fety

.

It s

ee

ms

tha

t th

ere

is a

pe

rce

ptio

n o

f st

ud

en

ts a

s a

ha

zard

to

pa

tien

ts a

nd

ho

w t

o

pro

tect

pa

tien

ts f

rom

stu

de

nts

.

7.

Re

sp

on

sib

ilit

y t

o

inte

rve

ne

in

s

itu

ati

on

s w

he

re a

p

ati

en

t’s

sa

fety

c

ou

ld b

e

co

mp

rom

ise

d

16

1

7

2

0

0

Of

the

fe

w p

rog

ram

s th

at

dis

cuss

ed

th

is it

em

, th

e m

ajo

rity

exp

ect

ed

ind

ivid

ua

l stu

de

nts

to

inte

rve

ne

in u

nsa

fe s

itua

tion

s. T

he

y a

lso

no

ted

, h

ow

eve

r, t

ha

t th

ey

ha

ve d

iffe

ren

t e

xpe

cta

tion

s o

f st

ud

en

ts a

t d

iffe

ren

t st

ag

es

of

pro

gra

m (

i.e.,

be

gin

nin

g s

tud

en

ts n

ee

d

mo

re h

elp

). O

vera

ll, t

he

re

spo

nse

s su

gg

est

ed

a f

ocu

s o

n in

div

idu

al r

esp

on

sib

ility

an

d

acc

ou

nta

bili

ty.

42

Fre

qu

en

cy

Dis

trib

uti

on

o

f S

ca

le R

es

po

ns

es

T

oo

l It

em

1a

1

b

2

3

4

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

8.

Re

po

rtin

g

sy

ste

ms

fo

r c

los

e

ca

lls

an

d a

dv

ers

e

ev

en

ts

13

1

4

3

0

1

Fo

r th

is it

em

, th

e m

ajo

rity

of

resp

on

de

nts

re

po

rte

d t

ha

t th

ey

tea

ch s

tud

en

ts h

ow

to

ke

ep

pa

tien

ts s

afe

(a

void

ad

vers

e e

ven

ts/c

lose

ca

lls)

an

d t

ha

t st

ud

en

ts h

ave

a d

uty

“.

..to

sp

ea

k u

p w

he

n t

he

y n

otic

e s

om

eth

ing

is d

on

e in

ap

pro

pri

ate

ly o

r w

ron

g”.

Inte

rest

ing

ly,

eq

ua

l nu

mb

ers

of

pa

rtic

ipa

nts

re

po

rte

d c

ove

rin

g t

he

co

nce

pts

of

rep

ort

ing

in

th

ree

se

ttin

gs:

clin

ica

l, la

b o

r cl

ass

roo

m.

It w

as

als

o n

ote

d b

y a

co

up

le o

f re

spo

nd

en

ts t

ha

t w

hile

stu

de

nts

ma

y h

ave

a r

esp

on

sib

ility

to

no

te s

yste

m d

efic

ien

cie

s,

the

y a

re n

ot

exp

ect

ed

to

“sp

ea

k u

p”

un

til t

he

y a

re a

te

am

me

mb

er.

9.

Co

mm

un

ica

tin

g

info

rma

tio

n a

bo

ut

clo

se

ca

lls

an

d

ad

ve

rse

ev

en

ts t

o

pa

tie

nts

an

d o

the

rs

11

1

3

1

1

2

Acc

ord

ing

to

th

e r

esp

on

de

nts

to

th

is it

em

, m

ost

pro

gra

ms

cove

r th

e c

on

cep

t o

f co

mm

un

ica

ting

info

rma

tion

ab

ou

t cl

ose

ca

lls/a

dve

rse

eve

nts

. C

on

sid

era

ble

va

ria

tion

e

xist

ed

with

ho

w t

his

co

nce

pt

is f

ram

ed

in t

he

cu

rric

ulu

m:

• E

thic

s, e

thic

al r

esp

on

sib

ility

•

Me

dic

o-l

eg

al a

spe

cts

(wh

o c

om

mu

nic

ate

s w

ith p

atie

nt

de

pe

nd

s o

n d

eg

ree

of

ad

vers

e e

ven

t)

• P

atie

nt

safe

ty a

nd

dis

clo

sure

•

Re

gu

lato

ry is

sue

s

A f

ew

pro

gra

ms

no

ted

th

at

stu

de

nts

wo

uld

like

ly c

om

mu

nic

ate

inte

rna

lly (

with

in t

he

te

am

) o

r w

ith o

the

r h

ea

lth p

rofe

ssio

na

ls.

Ag

ain

, th

e c

om

mu

nic

atio

n w

as

pe

rce

ive

d a

s a

n in

div

idu

al r

esp

on

sib

ility

by

a c

ou

ple

of

resp

on

de

nts

. A

ve

ry s

ma

ll n

um

be

r o

f re

spo

nd

en

ts d

iscu

sse

d a

str

on

g c

od

e o

f si

len

ce o

r “t

en

de

ncy

to

no

t ta

ttle

on

pa

rtn

er”

.

10

. S

up

po

rt

me

ch

an

ism

s f

or

tho

se

in

vo

lve

d i

n a

n

ad

ve

rse

ev

en

t,

inc

lud

ing

pa

tie

nts

a

nd

he

alt

hc

are

p

rov

ide

rs

9

6

5

2

3

Fo

r th

is it

em

, m

ost

of

the

re

spo

nd

en

ts in

dic

ate

d t

ha

t th

eir

pro

gra

ms

cove

r o

r p

rovi

de

su

pp

ort

me

cha

nis

ms

to s

tud

en

ts o

n a

n a

d h

oc,

info

rma

l ba

sis.

Ove

rall,

ind

ivid

ua

l st

ud

en

ts a

re r

esp

on

sib

le f

or

acc

ess

ing

su

pp

ort

s a

nd

usi

ng

th

e s

kills

th

ey

ha

ve b

ee

n

tau

gh

t (i

.e.,

str

ess

ma

na

ge

me

nt)

.

Th

e r

esp

on

ses

focu

sed

on

su

pp

ort

s a

vaila

ble

to

stu

de

nts

. N

o p

rog

ram

s id

en

tifie

d

cove

rin

g o

r p

rovi

din

g s

up

po

rt m

ech

an

ism

s fo

r p

atie

nts

.

43

Fre

qu

en

cy

Dis

trib

uti

on

o

f S

ca

le R

es

po

ns

es

T

oo

l It

em

1a

1

b

2

3

4

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

11

. P

rin

cip

les

an

d

pra

cti

ce

s o

f a

ju

st

an

d t

rus

tin

g c

ult

ure

12

1

2

2

0

3

Alth

ou

gh

no

ne

of

the

pro

gra

ms

spe

cific

ally

te

ach

ab

ou

t a

“ju

st a

nd

tru

stin

g c

ultu

re”,

all

of

the

re

spo

nd

en

ts c

ove

r e

lem

en

ts t

ha

t, in

th

eir

inte

rpre

tatio

n,

con

trib

ute

to

th

e

con

cep

t. J

ust

an

d t

rust

ing

wa

s in

terp

rete

d in

a n

um

be

r o

f w

ays

:

• E

thic

al d

uty

, e

lem

en

t o

f e

thic

s

• In

div

idu

al h

on

est

y

• P

atie

nt

con

fide

ntia

lity

•

Cu

ltura

l co

mp

ete

nce

, re

spe

ctfu

l of

div

ers

ity

• Ju

st s

oci

etie

s

• H

on

est

y a

bo

ut

ow

n le

arn

ing

A d

eg

ree

of

inte

rna

l in

con

sist

en

cy is

evi

de

nt

in t

he

re

sults

, h

ow

eve

r, a

s re

spo

nse

s o

n

oth

er

item

s su

gg

est

ed

a f

ea

r o

f re

po

rtin

g a

dve

rse

eve

nts

/clo

se c

alls

.

12

. T

he

co

ntr

ibu

tio

n

of

bo

th s

ys

tem

an

d

ind

ivid

ua

l fa

cto

rs t

o

oc

cu

rre

nc

e o

f a

dv

ers

e e

ve

nts

12

1

1

3

1

2

Le

ss t

ha

n h

alf

of

the

pro

gra

ms

tha

t e

lab

ora

ted

on

th

is r

esp

on

se r

ep

ort

ed

co

veri

ng

th

e

con

trib

utio

n o

f in

div

idu

al a

nd

sys

tem

fa

cto

rs t

o a

dve

rse

eve

nts

in t

he

ir c

urr

icu

lum

. T

he

w

ide

ra

ng

e o

f re

spo

nse

s re

vea

ls a

n e

mp

ha

sis

on

ind

ivid

ua

l co

ntr

ibu

tion

s to

th

e s

yste

m:

• C

on

fide

nt

ind

ivid

ua

l fa

cto

rs a

re c

ove

red

, so

me

co

nsi

de

ratio

n o

f sy

ste

m f

act

ors

(i

.e.,

org

an

iza

tion

of

clin

ica

l da

y)

• In

div

idu

al i

s co

nsi

de

red

with

in s

yste

m

•

Ind

ivid

ua

l fa

cto

rs c

on

trib

ute

to

sys

tem

• In

div

idu

al h

elp

less

ne

ss d

ue

to

sys

tem

fa

cto

rs

• In

div

idu

al a

nd

sys

tem

dis

cuss

ed

as

mu

tua

lly r

ein

forc

ing

in t

he

ory

(i.e

., s

taff

ing

le

vels

aff

ect

ind

ivid

ua

l),

no

t su

re s

yste

m v

ari

ab

les

are

co

nsi

de

red

in p

ract

ice

Th

e r

esp

on

ses

als

o s

ug

ge

st t

ha

t th

ere

wa

s u

nce

rta

inty

ab

ou

t w

ha

t is

me

an

t b

y sy

ste

m

fact

ors

. It

se

em

s th

at

the

pro

gra

ms

con

sid

er

the

ind

ivid

ua

l to

be

pa

rt o

f th

e s

yste

m a

nd

d

o n

ot

cove

r fa

cto

rs b

eyo

nd

or

ind

ep

en

de

nt

of

ind

ivid

ua

ls.

44

Fre

qu

en

cy

Dis

trib

uti

on

o

f S

ca

le R

es

po

ns

es

T

oo

l It

em

1a

1

b

2

3

4

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

13

. M

eth

od

s o

f in

ve

sti

ga

tin

g

sy

ste

m f

ac

tors

c

on

trib

uti

ng

to

an

a

dv

ers

e e

ve

nt

7

4

2

8

0

In t

ota

l, m

ore

th

an

ha

lf o

f th

e r

esp

on

de

nts

to

th

is it

em

re

po

rte

d t

ha

t th

ey

ha

ve a

me

tho

d

or

syst

em

fo

r in

vest

iga

ting

ad

vers

e e

ven

ts.

Of

the

se p

rog

ram

s, m

ost

co

ver

the

co

nce

pt

of

inve

stig

atin

g s

yste

m f

act

ors

in t

he

ory

(co

urs

es)

. S

om

e p

rog

ram

s n

ote

d t

ha

t a

ctu

ally

in

vest

iga

ting

sys

tem

fa

cto

rs is

be

yon

d t

he

ir c

on

tro

l (i.e

., p

art

of

the

inst

itutio

na

l do

ma

in,

no

t e

du

catio

na

l).

“We

inte

rpre

ted

th

is t

o m

ea

n w

ou

ld a

ctu

ally

te

ach

ab

ou

t th

e c

om

ple

xity

of

syst

em

; th

ese

ite

ms

are

sys

tem

s p

ers

pe

ctiv

e o

f a

dve

rse

eve

nt

an

d h

ow

we

tra

nsl

ate

th

is t

o

stu

de

nts

to

info

rm t

he

ir p

ract

ice

...

Do

n’t

alw

ays

ha

ve t

he

op

po

rtu

nity

to

an

aly

se t

he

is

sue

s a

nd

tra

nsl

ate

ba

ck t

o a

ca

se t

o u

se w

ith s

tud

en

ts”

14

. H

ow

to

us

e

lea

rnin

g f

rom

a

dv

ers

e e

ve

nts

to

in

flu

en

ce

ch

an

ge

in

s

ys

tem

s t

ha

t s

up

po

rt d

eli

ve

ry o

f s

afe

an

d e

ffe

cti

ve

c

are

8

4

7

2

1

Mo

st o

fte

n t

his

qu

est

ion

wa

s in

terp

rete

d a

s “D

o w

e u

se o

ur

ow

n s

tud

en

t p

ract

ice

si

tua

tion

s a

nd

use

ag

gre

ga

te d

ata

to

info

rm s

tud

en

t te

ach

ing

?”

Ove

rall,

it w

as

cle

ar

tha

t m

ore

th

an

ha

lf o

f th

e p

rog

ram

s d

o n

ot

cove

r th

is c

on

cep

t in

a s

yste

ma

tic w

ay.

If

cove

red

, th

e c

on

cep

t m

ay

be

dis

cuss

ed

in:

• C

ou

rse

s •

La

b/c

linic

al s

ett

ing

s •

Co

urs

es

an

d la

b/c

linic

al s

ett

ing

s •

Pra

ctic

um

– b

ut

vari

es

with

se

ttin

g

A c

ou

ple

of

resp

on

de

nts

be

lieve

d t

ha

t u

sin

g le

arn

ing

fro

m a

dve

rse

eve

nts

to

influ

en

ce

syst

em

s ch

an

ge

is n

ot

an

ap

pro

pri

ate

exp

ect

atio

n f

or

un

de

rgra

du

ate

cu

rric

ulu

m.

Ca

n w

e a

sk s

tud

en

ts t

o c

ha

ng

e t

he

sys

tem

wh

en

th

ey

are

just

lea

rnin

g h

ow

to

wo

rk

with

in it

?

45

Fre

qu

en

cy

Dis

trib

uti

on

o

f S

ca

le R

es

po

ns

es

T

oo

l It

em

1a

1

b

2

3

4

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

15

. Q

ua

lity

im

pro

ve

me

nt

me

tho

ds

to

su

pp

ort

d

eli

ve

ry o

f s

afe

an

d

eff

ec

tiv

e c

are

(e

.g.,

P

DS

A,

Six

Sig

ma

, L

ea

n)

5

2

2

6

5

On

ly o

ne

pro

gra

m r

ep

ort

ed

ha

vin

g a

fo

rma

lize

d q

ua

lity

imp

rove

me

nt

(QI)

pro

gra

m in

p

lace

. T

he

ma

jori

ty w

ho

re

spo

nd

ed

to

th

is it

em

me

ntio

ne

d in

teg

ratin

g Q

I co

nce

pts

in

the

ir c

urr

icu

lum

. A

fe

w a

lso

no

ted

th

at

QI

me

tho

ds

are

no

t e

ntr

y-to

-pra

ctic

e le

vel

con

cep

ts,

so t

he

y a

re n

ot

incl

ud

ed

in t

he

ir p

rog

ram

.

16

. T

he

ro

le o

f d

ata

to

im

pro

ve

sy

ste

ms

a

nd

su

pp

ort

d

eli

ve

ry o

f s

afe

an

d

eff

ec

tiv

e c

are

9

6

5

1

4

All

of

the

re

spo

nd

en

ts t

o t

his

ite

m d

esc

rib

ed

th

at

da

ta is

use

d in

th

eir

pro

gra

ms,

bu

t th

eir

inte

rpre

tatio

n a

nd

use

of

da

ta v

ari

ed

gre

atly

. “D

ata

” in

clu

de

d r

ese

arc

h li

tera

ture

, in

form

atio

n m

an

ag

em

en

t sy

ste

ms,

fe

ed

ba

ck o

n s

tud

en

ts’ p

erf

orm

an

ces

an

d b

est

p

ract

ice

gu

ide

line

s.

17

. C

ha

ng

e

ma

na

ge

me

nt

str

ate

gie

s t

o

imp

rov

e s

ys

tem

s

an

d s

up

po

rt

de

liv

ery

of

sa

fe a

nd

e

ffe

cti

ve

ca

re

7

5

2

5

2

Ne

arl

y a

ll o

f th

e r

esp

on

de

nts

to

th

is q

ue

stio

n r

ep

ort

ed

th

at

cha

ng

e is

co

nsi

de

red

in

the

ir p

rog

ram

. O

n f

urt

he

r re

flect

ion

, th

ey

ten

de

d t

o “

talk

ab

ou

t ch

an

ge

in g

en

era

l – b

ut

do

we

dis

cuss

ch

an

ge

dir

ect

ly t

o p

atie

nt

safe

ty?

” If

ch

an

ge

ma

na

ge

me

nt

is c

ove

red

, it

ten

ds

to b

e in

clu

de

d in

se

nio

r u

nd

erg

rad

ua

te/m

ast

ers

cu

rric

ulu

m.

46

Fre

qu

en

cy

Dis

trib

uti

on

o

f S

ca

le R

es

po

ns

es

T

oo

l It

em

1a

1

b

2

3

4

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

Sp

ec

ify

an

y o

the

r p

ati

en

t s

afe

ty

co

nc

ep

ts i

nc

lud

ed

in

yo

ur

pro

gra

m t

ha

t a

re n

ot

lis

ted

ab

ov

e

an

d r

ate

th

em

us

ing

th

e s

am

e s

ca

le

M

ost

of

the

re

spo

nd

en

ts w

ho

an

swe

red

th

is q

ue

stio

n s

ug

ge

ste

d in

clu

din

g c

on

cep

ts

rela

ted

to

ind

ivid

ua

l re

spo

nsi

bili

ty f

or

pa

tien

t sa

fety

, su

ch a

s:

• 6

rig

hts

of

me

dic

atio

n a

dm

inis

tra

tion

•

En

viro

nm

en

tal s

afe

ty,

fire

sa

fety

•

Pra

ctiti

on

er

he

alth

an

d c

om

pe

ten

ce

A c

ou

ple

als

o n

ote

d t

ha

t it

is im

po

rta

nt

to c

on

sid

er

the

psy

cho

log

ica

l ha

rm r

ela

ted

to

p

hys

ica

l ad

vers

e e

ven

ts.

Do

yo

u o

ffe

r a

s

pe

cif

ic c

ou

rse

or

mo

du

le i

n y

ou

r p

rog

ram

th

at

is

foc

us

ed

on

th

e t

op

ic

of

pa

tie

nt

sa

fety

a

nd

/or

qu

ali

ty

imp

rov

em

en

t?

S

ince

on

ly a

co

up

le o

f p

rog

ram

s sp

eci

fica

lly id

en

tifie

d p

atie

nt

safe

ty m

od

ule

s/co

urs

es,

it

is r

ea

son

ab

le t

o a

ssu

me

th

at

mo

st in

teg

rate

pa

tien

t sa

fety

co

nce

pts

th

rou

gh

ou

t th

eir

cu

rric

ulu

m.

Re

spo

nd

en

ts id

en

tifie

d t

he

fo

llow

ing

co

nce

pts

inte

gra

ted

into

co

urs

es:

• R

isk

ma

na

ge

me

nt

• S

afe

ty is

sue

s in

wo

rkp

lace

co

urs

es

• R

ole

of

safe

ty a

nd

re

po

rtin

g

• B

iom

ech

an

ics,

ro

le o

f is

ola

tion

•

La

b s

afe

ty

• In

fect

ion

an

d p

reve

ntio

n c

on

tro

l •

Ho

w t

o h

an

dle

ma

teri

al a

t p

atie

nt

inte

ract

ion

•

Pa

tien

t sa

fety

– in

un

it o

n p

rofe

ssio

na

l iss

ue

s (r

eg

ula

tory

, le

ga

l ru

les,

co

mm

un

ica

tion

)

Are

all

th

es

e

qu

es

tio

ns

im

po

rta

nt?

M

ost

of

the

re

spo

nd

en

ts t

o t

his

ite

m b

elie

ved

th

e q

ue

stio

ns

in T

he

me

1 a

re im

po

rta

nt.

A

fe

w,

ho

we

ver,

su

gg

est

ed

th

e la

tte

r q

ue

stio

ns

(#1

3-1

7)

we

re n

ot

rele

van

t to

u

nd

erg

rad

ua

te c

urr

icu

lum

.

47

Th

em

e 2

: L

ea

de

rsh

ip a

nd

org

an

iza

tio

na

l fa

cto

rs t

ha

t s

up

po

rt a

sy

ste

ms

-ori

en

ted

ap

pro

ac

h t

o p

ati

en

t s

afe

ty

Ra

tin

g S

ca

le (

se

lec

t o

nly

on

e):

1

= N

ot

do

ing

an

yth

ing

in t

his

are

a a

t th

e m

om

en

t (i

.e.

aw

are

bu

t n

o a

ctio

n t

ake

n)

2 =

Sta

rtin

g t

o c

on

sid

er

this

(i.e

., in

form

atio

n g

ath

eri

ng

an

d/o

r d

iscu

ssio

n/p

lan

nin

g u

nd

erw

ay)

3

= I

n t

he

pro

cess

of

imp

lem

en

ting

(i.e

., p

lan

in p

lace

an

d t

aki

ng

so

me

act

ion

)

4 =

Im

ple

me

nte

d o

r in

teg

rate

d in

to t

he

pro

gra

m (

i.e.

do

ing

th

is in

ou

r p

rog

ram

)

5 =

Do

n’t

kno

w/n

ee

d m

ore

info

rma

tion

to

de

cid

e

Fre

qu

en

cy

D

istr

ibu

tio

n o

f S

ca

le

Re

sp

on

se

s

To

ol

Ite

m

1

2

3

4

5

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

1.

A c

lea

r d

isti

nc

tio

n i

s m

ad

e

be

twe

en

a

sy

ste

ms

-ori

en

ted

a

pp

roa

ch

to

pa

tie

nt

sa

fety

an

d a

n

ind

ivid

ua

l p

rac

titi

on

er

res

po

ns

ibil

ity

fo

r s

afe

pa

tie

nt

ca

re

1

2

2

11

2

R

esp

on

de

nts

se

em

ed

to

str

ug

gle

with

th

is q

ue

stio

n.

Wh

ile h

alf

we

re u

nce

rta

in

ab

ou

t h

ow

mu

ch d

istin

ctio

n is

ma

de

be

twe

en

ind

ivid

ua

l an

d s

yste

m,

just

less

th

an

ha

lf o

f th

e r

esp

on

ses

to t

his

qu

est

ion

did

n’t

kno

w w

ha

t a

sys

tem

s a

pp

roa

ch is

.

In t

he

en

d,

som

e s

elf-

de

fine

d a

sys

tem

s a

pp

roa

ch in

th

eir

an

swe

r.

• “…

un

de

rsta

nd

th

at

it’s

no

t th

e p

ers

on

’s f

au

lt if

som

eth

ing

go

es

wro

ng

–

if a

n e

rro

r ke

ep

s o

ccu

rrin

g it

is a

sig

n t

ha

t th

e s

yste

m h

as

pro

ble

ms”

•

“In

clin

ica

l, ta

lk a

bo

ut

syst

em

s o

ccu

rrin

g o

n t

he

un

it th

at

con

trib

ute

to

e

rro

rs (

i.e.,

ph

arm

acy

sys

tem

s) a

nd

so

cio

po

litic

al f

act

ors

”

On

ly t

wo

pro

gra

ms

fra

me

d t

he

ir a

nsw

er

in t

erm

s o

f a

lea

de

r’s

role

– b

ut

the

y w

on

de

red

: “W

ha

t is

a le

ad

er’

s ro

le w

ith r

eg

ard

to

th

is –

un

de

rsta

nd

ing

, te

ach

ing

?”

2.

Pa

tie

nt

sa

fety

is

in

clu

de

d a

s a

n

ex

pli

cit

pri

ori

ty i

n

the

ed

uc

ati

on

p

rog

ram

0

0

4

13

1

A

bo

ut

ha

lf o

f th

e r

esp

on

de

nts

to

th

is q

ue

stio

ns

no

ted

th

at

pa

tien

t sa

fety

is “

the

u

ltim

ate

go

al o

f e

very

thin

g w

e d

o in

th

e p

rog

ram

”. A

ltho

ug

h o

ne

pro

gra

m

no

ted

th

at

a s

yste

ms

ap

pro

ach

to

pa

tien

t sa

fety

is a

n a

ccre

dita

tion

re

qu

ire

me

nt,

ha

lf w

ere

less

ce

rta

in a

bo

ut

ho

w e

xplic

itly

the

co

nce

pts

are

in

clu

de

d.

48

Fre

qu

en

cy

D

istr

ibu

tio

n o

f S

ca

le

Re

sp

on

se

s

To

ol

Ite

m

1

2

3

4

5

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

3.

A s

en

ior

ad

min

istr

ati

ve

le

ad

er

in t

he

p

rog

ram

d

em

on

str

ate

s

vis

ion

an

d

co

mm

itm

en

t to

a

sy

ste

ms

-ori

en

ted

a

pp

roa

ch

to

pa

tie

nt

sa

fety

an

d q

ua

lity

1

4

1

10

2

M

ore

th

an

ha

lf w

ho

co

mm

en

ted

on

th

is q

ue

stio

n b

elie

ved

a s

en

ior

ad

min

istr

ato

r in

th

eir

pro

gra

m d

em

on

stra

ted

vis

ion

an

d c

om

mitm

en

t to

pa

tien

t sa

fety

. T

he

re

spo

nse

s w

ere

less

cle

ar

ab

ou

t w

he

the

r th

e c

om

mitm

en

t w

as

to

a s

yste

ms

ap

pro

ach

to

pa

tien

t sa

fety

an

d q

ua

lity.

Ove

rall,

th

e a

nsw

ers

to

th

is q

ue

stio

n t

en

de

d t

o f

ocu

s o

n o

ne

of

the

ele

me

nts

o

f th

is q

ue

stio

n o

r w

ere

va

gu

e.

It s

ho

uld

be

no

ted

th

at

in m

ost

ca

ses,

as

req

ue

ste

d b

y H

QC

A,

a s

en

ior

ad

min

istr

ato

r w

as

pa

rtic

ipa

ting

in t

he

inte

rvie

w g

rou

p.

Th

is m

ay

ha

ve in

hib

ited

o

the

r g

rou

p m

em

be

rs’ a

sse

ssm

en

t o

f se

nio

r a

dm

inis

tra

tor

visi

on

an

d

com

mitm

en

t.

4.

Th

e p

rog

ram

ha

s

fac

ult

y m

em

be

r(s

) w

ith

re

co

gn

ize

d

ex

pe

rtis

e i

n p

ati

en

t s

afe

ty a

nd

/or

qu

ali

ty w

ho

ca

n

se

rve

as

ro

le

mo

de

ls a

nd

th

ou

gh

t le

ad

ers

0

1

3

13

1

N

ea

rly

all

of

the

re

spo

nd

en

ts r

ep

ort

ed

th

ey

ha

d f

acu

lty w

ith e

xpe

rtis

e in

p

atie

nt

safe

ty.

Th

e r

ole

of

the

pe

rso

n w

ith e

xpe

rtis

e v

ari

ed

(i.e

., c

linic

al,

cla

ssro

om

, m

an

ag

em

en

t) a

nd

a c

ou

ple

of

resp

on

de

nts

str

ug

gle

d w

ith w

ha

t w

as

reco

gn

ize

d e

xpe

rtis

e.

Po

ten

tial s

ou

rce

s o

f le

ad

ers

hip

incl

ud

ed

:

• C

linic

al i

nst

ruct

ors

with

“ve

ry h

igh

sta

nd

ard

s in

pa

tien

t sa

fety

an

d

qu

alit

y”

• F

acu

lty –

bu

t n

ot

spe

cifie

d f

urt

he

r

• S

ess

ion

al f

acu

lty

• In

stru

cto

rs

• S

en

ior

ma

na

ge

rs

49

Fre

qu

en

cy

D

istr

ibu

tio

n o

f S

ca

le

Re

sp

on

se

s

To

ol

Ite

m

1

2

3

4

5

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

5.

Fa

cu

lty

me

mb

ers

p

art

icip

ate

in

fa

cu

lty

d

ev

elo

pm

en

t p

rog

ram

s r

ela

ted

to

a

sy

ste

ms

-ori

en

ted

a

pp

roa

ch

to

pa

tie

nt

sa

fety

an

d q

ua

lity

4

2

0

8

4

Alth

ou

gh

th

e r

esp

on

de

nts

to

th

is q

ue

stio

n r

ep

ort

ed

th

at

pro

fess

ion

al

de

velo

pm

en

t o

ccu

rs in

th

eir

pro

gra

m,

the

y n

ote

d t

ha

t it

is n

ot

spe

cific

to

a

syst

em

s a

pp

roa

ch o

r lim

ited

to

pa

tien

t sa

fety

. M

an

y a

lso

re

po

rte

d t

ha

t p

rofe

ssio

na

l de

velo

pm

en

t o

ccu

rs in

form

ally

, su

ch a

s a

tte

nd

ing

co

nfe

ren

ces

an

d s

ha

rin

g in

form

atio

n w

ith c

olle

ag

ue

s. P

rofe

ssio

na

l de

velo

pm

en

t re

late

d t

o

a s

yste

ms-

ori

en

ted

ap

pro

ach

to

pa

tien

t sa

fety

wa

s su

mm

ed

up

by

a

resp

on

de

nt

as

follo

ws:

“T

he

re a

re s

o m

an

y co

mp

etin

g f

acu

lty d

eve

lop

me

nt

ne

ed

s –

ho

w t

o p

rio

ritiz

e?

”

6.

Pa

tie

nt

sa

fety

is

v

iew

ed

as

a

co

nc

ep

t th

at

sh

ou

ld b

e

inte

gra

ted

ac

ros

s

the

cu

rric

ulu

m

rath

er

tha

n t

au

gh

t a

s a

sta

nd

-alo

ne

to

pic

0

2

1

15

0

M

ost

of

the

re

spo

nd

en

ts t

o t

his

ite

m r

ep

ort

ed

th

at

pa

tien

t sa

fety

co

nce

pts

are

in

teg

rate

d a

cro

ss t

he

cu

rric

ulu

m.

Ple

ase

no

te t

ha

t th

is is

co

nsi

ste

nt

with

re

spo

nse

s in

th

em

e 1

, w

he

re o

nly

2 p

rog

ram

s re

po

rte

d t

he

y h

ave

a s

pe

cific

m

od

ule

/co

urs

e d

evo

ted

to

pa

tien

t sa

fety

.

50

Fre

qu

en

cy

D

istr

ibu

tio

n o

f S

ca

le

Re

sp

on

se

s

To

ol

Ite

m

1

2

3

4

5

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

7.

As

th

e

cu

rric

ulu

m i

s b

ein

g

rev

iew

ed

, c

on

sid

era

tio

n i

s

giv

en

to

ho

w

pa

tie

nt

sa

fety

-re

late

d c

on

ce

pts

a

nd

co

nte

nt

ca

n b

e

inte

gra

ted

in

to t

he

c

urr

icu

lum

1

4

1

11

1

W

he

n d

iscu

ssin

g t

his

ite

m,

ma

ny

resp

on

de

nts

re

po

rte

d t

ha

t cu

rric

ulu

m r

evi

ew

p

roce

sse

s a

re o

ng

oin

g in

th

eir

pro

gra

m,

or

tha

t cu

rric

ulu

m d

eve

lop

me

nt

is in

p

roce

ss.

Mo

st d

id n

ot

spe

cify

, h

ow

eve

r, if

th

ere

wa

s a

sp

eci

fic p

atie

nt

safe

ty

focu

s o

r m

an

da

te w

ith t

he

re

vie

w.

8.

A f

lex

ible

c

urr

icu

lum

d

ev

elo

pm

en

t p

roc

es

s a

llo

ws

c

urr

icu

lum

to

be

a

da

pte

d o

r u

pd

ate

d

in a

tim

ely

wa

y i

n

res

po

ns

e t

o

imp

ort

an

t d

ev

elo

pm

en

ts i

n

he

alt

hc

are

pra

cti

ce

s

uc

h a

s p

ati

en

t s

afe

ty

1

1

1

14

1

A

ll w

ho

ela

bo

rate

d o

n t

his

ite

m in

dic

ate

d t

ha

t th

eir

cu

rric

ulu

m is

ad

ap

ted

or

up

da

ted

to

re

flect

ne

w k

no

wle

dg

e.

Ab

ou

t h

alf

of

the

re

spo

nd

en

ts a

lso

no

ted

th

at

curr

icu

lum

ch

an

ge

s o

ccu

r th

rou

gh

a p

roce

ss t

ha

t in

volv

es

diff

ere

nt

laye

rs

of

ap

pro

val a

nd

ta

kes

time

.

Ma

ny

no

ted

th

at

curr

icu

lum

ch

an

ge

s ca

n o

ccu

r m

ore

qu

ickl

y in

lab

s th

an

in

cou

rse

s. F

urt

he

rmo

re,

ch

an

ge

s a

cro

ss c

olla

bo

rativ

e p

rog

ram

s ta

ke m

uch

lo

ng

er:

“…ta

kes

time

to

ch

an

ge

a c

on

cep

t a

cro

ss c

olla

bo

ratin

g p

rog

ram

s’ c

urr

icu

la s

o

it d

oe

sn’t

ha

pp

en

qu

ickl

y”

Ne

arl

y a

ll o

f th

e r

esp

on

de

nts

de

scri

be

d t

he

ir c

urr

icu

lum

ch

an

ge

pro

cess

, b

ut

did

no

t co

mm

en

t sp

eci

fica

lly o

n in

corp

ora

tion

of

safe

ty-r

ela

ted

ch

an

ge

s (s

eco

nd

ha

lf o

f q

ue

stio

n).

51

Fre

qu

en

cy

D

istr

ibu

tio

n o

f S

ca

le

Re

sp

on

se

s

To

ol

Ite

m

1

2

3

4

5

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

9.

Pa

rtn

ers

hip

s o

r c

oll

ab

ora

tio

ns

are

e

sta

bli

sh

ed

wit

h

oth

er

he

alt

h c

are

p

rov

ide

r e

du

ca

tio

n

pro

gra

ms

to

s

up

po

rt

inte

rdis

cip

lin

ary

e

du

ca

tio

n

2

5

2

9

0

Wh

ile ju

st o

ver

ha

lf o

f th

e p

rog

ram

re

spo

nd

en

ts o

n t

his

ite

m in

dic

ate

d t

ha

t th

eir

stu

de

nts

pa

rtic

ipa

te in

inte

rdis

cip

lina

ry e

du

catio

n,

som

e a

lso

re

po

rte

d

tha

t th

ey

are

in t

he

ea

rly

sta

ge

s o

f d

eve

lop

ing

inte

rdis

cip

lina

ry

curr

icu

lum

/pro

gra

ms.

A c

ou

ple

of

resp

on

de

nts

als

o n

ote

d t

ha

t in

terd

isci

plin

ary

co

llab

ora

tion

is li

mite

d b

y p

ract

ica

l ch

alle

ng

es

or

ba

rrie

rs.

Ab

ou

t h

alf

of

the

re

spo

nd

en

ts r

ep

ort

ed

th

at

inte

rdis

cip

lina

ry c

ou

rse

s a

re

off

ere

d t

o s

tud

en

ts,

bu

t o

nly

on

e r

esp

on

de

nt

talk

ed

ab

ou

t th

e p

rese

nce

of

inte

rdis

cip

lina

ry f

acu

lty.

10

. In

terd

isc

ipli

na

ry

lea

rnin

g

op

po

rtu

nit

ies

are

in

clu

de

d i

n t

he

p

rog

ram

to

pre

pa

re

stu

de

nts

to

wo

rk

eff

ec

tiv

ely

in

te

am

s

0

3

2

13

0

R

esp

on

de

nts

on

th

is it

em

cla

rifie

d t

ha

t in

terd

isci

plin

ary

lea

rnin

g o

pp

ort

un

itie

s a

re d

iffe

ren

t in

clin

ica

l an

d t

he

cla

ssro

om

. M

ore

th

an

ha

lf o

f th

e p

rog

ram

s h

ave

inte

rdis

cip

lina

ry o

pp

ort

un

itie

s in

clin

ica

l. A

ltho

ug

h n

on

e r

ep

ort

ed

in

terd

isci

plin

ary

op

po

rtu

niti

es

in c

lass

roo

m o

nly

, a

fe

w d

esc

rib

ed

in

terd

isci

plin

ary

clin

ica

l an

d c

lass

roo

m e

xpe

rie

nce

s.

11

. L

ea

rnin

g

op

po

rtu

nit

ies

are

in

clu

de

d i

n t

he

p

rog

ram

to

pre

pa

re

stu

de

nts

to

wo

rk

co

lla

bo

rati

ve

ly w

ith

p

ati

en

ts a

nd

fa

mil

ies

0

0

0

18

0

A

ga

in,

acc

ord

ing

to

th

ose

wh

o c

om

me

nte

d o

n t

his

qu

est

ion

, p

rog

ram

s se

em

to

em

ph

asi

ze t

he

clin

ica

l se

ttin

g f

or

stu

de

nts

to

lea

rn h

ow

to

wo

rk

colla

bo

rativ

ely

with

pa

tien

ts a

nd

fa

mili

es.

Ne

arl

y a

ll o

f th

e n

ine

pro

gra

ms

tha

t re

spo

nd

ed

de

scri

be

d c

linic

al e

xpe

rie

nce

s, w

hile

a f

ew

of

the

se p

rog

ram

s a

lso

co

vere

d c

olla

bo

ratio

n in

cla

ss.

52

Fre

qu

en

cy

D

istr

ibu

tio

n o

f S

ca

le

Re

sp

on

se

s

To

ol

Ite

m

1

2

3

4

5

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

12

. C

lin

ica

l te

ac

he

rs w

ho

m

en

tor

stu

de

nts

d

uri

ng

th

eir

p

rac

tic

al

lea

rnin

g

ex

pe

rie

nc

es

are

e

xp

ec

ted

to

ha

ve

k

no

wle

dg

e o

f th

e

sy

ste

ms

ap

pro

ac

h

to p

ati

en

t s

afe

ty

an

d q

ua

lity

4

1

3

10

0

A

bo

ut

ha

lf o

f th

e r

esp

on

de

nts

to

th

is it

em

an

swe

red

ha

lf o

f th

e q

ue

stio

n.

Th

ey

exp

ect

inst

ruct

ors

to

ha

ve k

no

wle

dg

e o

f p

atie

nt

safe

ty a

nd

qu

alit

y, b

ut

no

t n

ece

ssa

rily

fro

m a

sys

tem

s p

ers

pe

ctiv

e.

A f

ew

fu

rth

er

ela

bo

rate

d t

ha

t th

ey

“im

plic

itly

ho

pe

ou

r in

stru

cto

rs h

ave

kn

ow

led

ge

of

pa

tien

t sa

fety

an

d q

ua

lity

–

bu

t it

is n

ot

a p

urp

ose

ful f

ocu

s in

ori

en

tatio

n.”

Wh

ile a

pro

gra

m in

dic

ate

d w

ork

on

a s

yste

ms

ap

pro

ach

is in

-pro

gre

ss,

mo

re

tha

n h

alf

of

the

re

spo

nd

en

ts d

id n

ot

ad

dre

ss t

he

sys

tem

s p

art

of

the

qu

est

ion

. T

ho

se w

ho

did

an

swe

r d

esc

rib

ed

th

at

the

y h

ave

“…

an

exp

ect

atio

n t

ha

t th

ey

[inst

ruct

ors

] u

nd

ers

tan

d t

he

en

viro

nm

en

t in

wh

ich

th

ey

are

pra

ctic

ing

…”

Th

is

inte

rpre

tatio

n o

f sy

ste

ms

ap

pro

ach

se

em

ed

to

en

com

pa

ss k

no

wle

dg

e o

f h

osp

ital p

olic

ies

an

d p

roce

du

res.

Sp

ec

ify

an

y o

the

r le

ad

ers

hip

or

org

an

iza

tio

na

l fa

cto

rs,

tha

t s

up

po

rt a

sy

ste

ms

-o

rie

nte

d a

pp

roa

ch

to

pa

tie

nt

sa

fety

in

y

ou

r p

rog

ram

, th

at

no

t li

ste

d a

bo

ve

H

alf

of

the

re

spo

nd

en

ts t

o t

he

qu

est

ion

su

gg

est

ed

th

at

com

mitm

en

t fr

om

p

eo

ple

at

mu

ltip

le le

vels

in t

he

pro

gra

m,

such

as

cla

ssro

om

inst

ruct

ors

, fa

culty

co

un

cil m

em

be

rs,

an

d s

en

ior

lea

de

rs,

wo

uld

bu

ild s

up

po

rt f

or

a

syst

em

s a

pp

roa

ch t

o p

atie

nt

safe

ty in

th

eir

pro

gra

ms.

Fu

rth

er

to t

his

po

int,

a

pro

gra

m a

lso

be

lieve

d in

terd

isci

plin

ary

ch

am

pio

ns

are

imp

ort

an

t fo

r a

dva

nci

ng

a s

yste

ms

ap

pro

ach

. O

the

rs t

ho

ug

ht

it w

ou

ld b

e im

po

rta

nt

to

incr

ea

se p

rofe

ssio

na

l de

velo

pm

en

t w

ith f

acu

lty “

…p

rio

r to

lau

nch

of

ne

w

safe

ty in

itia

tive

” a

nd

incr

ea

se f

acu

lty u

nd

ers

tan

din

g o

f sy

ste

ms

tha

t w

ork

to

ge

the

r (i

.e.,

ed

uca

tion

pro

gra

ms

an

d A

HS

).

53

Fre

qu

en

cy

D

istr

ibu

tio

n o

f S

ca

le

Re

sp

on

se

s

To

ol

Ite

m

1

2

3

4

5

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

Are

all

th

es

e

qu

es

tio

ns

im

po

rta

nt?

A

ma

jori

ty o

f re

spo

nd

en

ts b

elie

ved

th

ese

qu

est

ion

s a

re im

po

rta

nt.

“T

he

y re

min

d le

ad

ers

hip

ab

ou

t w

ha

t o

ug

ht

to b

e t

ho

ug

ht

ab

ou

t in

te

rms

of

thin

gs

tha

t a

re k

ey

to p

atie

nt

safe

ty”

A c

ou

ple

, h

ow

eve

r, d

id n

ot

thin

k a

ll o

f th

e q

ue

stio

ns

we

re im

po

rta

nt:

“So

me

we

do

no

t a

gre

e w

ith t

he

me

an

ing

of…

[fo

r e

xam

ple

] #

4 –

ho

w y

ou

lo

ok

at

exp

ert

ise

. Is

th

at

est

ab

lish

ed

re

sea

rch

er?

If

so

, is

th

at

qu

est

ion

re

leva

nt?

Bu

t if

the

qu

est

ion

is lo

oki

ng

at

tha

t w

e w

an

t to

ha

ve r

ole

mo

de

ls

with

inte

rest

in t

his

are

a t

he

n it

is a

re

leva

nt

qu

est

ion

.”

Are

th

ere

im

po

rta

nt

qu

es

tio

ns

mis

sin

g?

Th

is q

ue

stio

n h

ad

th

e g

rea

test

nu

mb

er

of

resp

on

ses

in t

his

th

em

e.

Re

spo

nd

en

ts’ s

ug

ge

stio

ns

focu

sed

on

incr

ea

sin

g t

he

cla

rity

of

too

l ite

ms

in

ord

er

to m

ake

inte

rpre

tatio

n s

imp

ler.

Se

vera

l no

ted

th

at

the

co

nce

pt

of

a

syst

em

s a

pp

roa

ch is

ne

w a

nd

ne

ed

s to

be

exp

lain

ed

in o

rde

r fo

r th

e r

ea

de

r to

fu

lly u

nd

ers

tan

d t

he

pa

tien

t sa

fety

se

lf-a

sse

ssm

en

t to

ol.

A q

ue

stio

n c

ou

ld

ask

:

“Is

the

re a

sta

nd

ard

ize

d a

pp

roa

ch f

or

syst

em

ap

pro

ach

to

pa

tien

t sa

fety

in

you

r o

rga

niz

atio

n?

”

An

oth

er

resp

on

de

nt

sug

ge

ste

d e

xpa

nd

ing

co

nsi

de

ratio

n o

f sa

fety

/ris

k b

eyo

nd

ph

ysic

al h

arm

to

“co

nsi

de

r o

the

r ty

pe

s o

f sa

fety

– p

ote

ntia

l fo

r p

sych

olo

gic

al,

em

otio

na

l, a

nd

cu

ltura

l ha

rm”.

Se

vera

l ad

diti

on

al q

ue

stio

ns

we

re p

rop

ose

d:

Ask

ing

ab

ou

t a

pp

lica

tion

of

lea

rnin

g is

mis

sin

g (

i.e.,

do

op

po

rtu

niti

es

for

inte

rdis

cip

lina

ry w

ork

ava

ilab

le)

54

Fre

qu

en

cy

D

istr

ibu

tio

n o

f S

ca

le

Re

sp

on

se

s

To

ol

Ite

m

1

2

3

4

5

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

Are

th

ere

im

po

rta

nt

qu

es

tio

ns

m

iss

ing

?

(co

nti

nu

ed

)

A

dd

co

nsi

de

ratio

n o

f cl

inic

al a

ge

nci

es

to e

nsu

re a

lign

me

nt

be

twe

en

e

du

catio

na

l pro

gra

ms

an

d p

ract

icu

m.

“Do

yo

u f

ee

l th

at

you

r e

du

catio

na

l pro

gra

m c

olla

bo

rate

s w

ith c

linic

al

ag

en

cie

s o

r cl

inic

al a

ge

nci

es

colla

bo

rate

with

ed

uca

tion

al p

rog

ram

to

en

sure

p

atie

nt

safe

ty?

”

Ho

w t

o a

sse

ss s

tud

en

t u

nd

ers

tan

din

g,

rete

ntio

n a

nd

th

en

ap

plic

atio

n o

f sy

ste

ms

ap

pro

ach

to

pa

tien

t sa

fety

aft

er

gra

du

atio

n?

Ho

w t

o k

no

w if

th

ey

pra

ctic

e w

ha

t is

pre

ach

ed

?

Ask

ab

ou

t in

terd

isci

plin

ary

lea

de

rsh

ip f

or

syst

em

ap

pro

ach

to

pa

tien

t sa

fety

:

If r

ea

lly h

ave

lea

de

rsh

ip in

sys

tem

s o

rie

nta

tion

pa

tien

t sa

fety

, m

igh

t n

ee

d t

o

ha

ve le

ad

ers

hip

acr

oss

diff

ere

nt

dis

cip

line

s –

i.e

., D

ea

ns

of

nu

rsin

g,

me

dic

ine

, p

ha

rma

cy (

etc

.) a

nd

pra

ctic

e s

ett

ing

s co

llab

ora

tive

ly p

lan

th

e

syst

em

s a

pp

roa

ch t

o s

afe

ty.

Do

ed

uca

tion

al p

rog

ram

lea

de

rs c

olla

bo

rate

to

m

ake

de

cisi

on

ab

ou

t e

du

catio

na

l pro

gra

mm

ing

?

Ad

d a

qu

est

ion

wh

eth

er

the

ed

uca

tion

al p

rog

ram

’s c

ultu

re s

up

po

rts

a

syst

em

s a

pp

roa

ch t

o p

atie

nt

safe

ty.

Sh

ou

ld t

he

re b

e a

qu

est

ion

ab

ou

t si

mu

latio

n a

nd

inco

rpo

ratio

n o

f th

is in

to la

b

to g

ive

stu

de

nts

co

nfid

en

ce o

f sa

fety

wh

en

th

ey

ge

t to

clin

ica

l se

ttin

g?

Ask

ab

ou

t e

du

catio

na

l pro

gra

m’s

re

ach

an

d a

uth

ori

ty.

Ma

y h

ave

lim

ited

o

pp

ort

un

itie

s to

eff

ect

ch

an

ge

in h

ea

lth c

are

org

an

iza

tion

s (i

.e.,

ca

n r

ais

e

issu

es,

bu

t h

ave

no

influ

en

ce o

ver

cha

ng

es)

.

55

Th

em

e 3

: R

es

po

nd

ing

to

clo

se

ca

lls

an

d a

dv

ers

e e

ve

nts

in

vo

lvin

g s

tud

en

ts

Ra

tin

g S

ca

le (

se

lec

t o

nly

on

e):

1

= N

ot

do

ing

an

yth

ing

in t

his

are

a a

t th

e m

om

en

t (i

.e.,

ma

y b

e a

wa

re b

ut

no

act

ion

ta

ken

) 2

= S

tart

ing

to

co

nsi

de

r th

is (

i.e.,

info

rma

tion

ga

the

rin

g a

nd

/or

dis

cuss

ion

/pla

nn

ing

un

de

rwa

y)

3 =

In

th

e p

roce

ss o

f im

ple

me

ntin

g (

i.e.,

pla

n in

pla

ce a

nd

ta

kin

g s

om

e a

ctio

n)

4

= I

mp

lem

en

ted

or

inte

gra

ted

into

th

e p

rog

ram

(i.e

. d

oin

g t

his

in o

ur

pro

gra

m)

5 =

Do

n’t

kno

w/n

ee

d m

ore

info

rma

tion

to

de

cid

e

Fre

qu

en

cy

Dis

trib

uti

on

o

f S

ca

le R

es

po

ns

es

T

oo

l It

em

1

2

3

4

5

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

56

Fre

qu

en

cy

Dis

trib

uti

on

o

f S

ca

le R

es

po

ns

es

T

oo

l It

em

1

2

3

4

5

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

1.

Th

ere

is

a

pro

ce

ss

in

pla

ce

to

re

vie

w c

los

e c

all

s

an

d a

dv

ers

e e

ve

nts

in

wh

ich

stu

de

nts

a

re i

nv

olv

ed

du

rin

g

cli

nic

al/

pra

cti

ca

l le

arn

ing

e

xp

eri

en

ce

s,

in

ord

er

to d

ete

rmin

e

the

co

ntr

ibu

tio

n o

f b

oth

sy

ste

m-r

ela

ted

fa

cto

rs (

he

alt

h

sy

ste

m a

nd

e

du

ca

tio

n p

rog

ram

) a

nd

stu

de

nt

fac

tors

3

3

2

8

2

Th

e m

ajo

rity

of

resp

on

de

nts

ind

ica

ted

th

at

the

y d

o n

ot

ha

ve a

sys

tem

in p

lace

to

tra

ck

the

se e

ven

ts a

nd

to

lea

rn f

rom

th

em

. T

he

y re

ly o

n t

he

clin

ica

l se

ttin

g t

o h

ave

po

licie

s in

p

lace

. W

he

n t

he

y h

ave

info

rma

tion

, o

nly

a c

ou

ple

of

site

s lo

ok

at

it to

ass

ess

if a

sy

ste

m f

act

or

con

trib

ute

d t

o t

he

eve

nt.

No

on

e s

tate

d t

he

y u

se t

he

da

ta in

ag

gre

ga

ted

fo

rm a

nd

ove

r tim

e.

1)

Pro

cess

in p

lace

fo

r cl

ose

ca

ll:

Th

e m

ajo

rity

of

resp

on

de

nts

ind

ica

ted

th

ey

ha

ve s

om

e f

orm

of

form

al o

r in

form

al

pro

cess

es

in p

lace

to

re

po

rt a

nd

fin

d o

ut

ab

ou

t cl

ose

ca

lls a

nd

ad

vers

e e

ven

ts.

Bu

t th

ere

are

hu

ge

ga

ps:

•

Ed

uca

tion

inst

itutio

ns

see

m t

o r

ely

on

AH

S a

nd

oth

er

clin

ica

l se

ttin

gs

to h

ave

sy

ste

ms

in p

lace

. •

Ha

lf o

f re

spo

nd

en

ts h

ave

no

fo

rma

l pro

cess

bu

t re

ly o

n t

he

clin

ica

l se

ttin

g t

o

“ha

nd

le it

”.

• S

om

e r

ep

ort

th

ey

do

n’t

ge

t a

ny

fee

db

ack

fro

m t

he

clin

ica

l se

ttin

g b

ut

the

y a

ssu

me

it is

ha

nd

led

acc

ord

ing

to

pla

cem

en

t p

olic

y.

• L

ess

th

an

ha

lf st

ate

cle

arl

y th

at

the

y h

ave

fo

rma

l pro

cess

in p

lace

.

2)

De

term

inin

g c

on

trib

utio

n:

T

he

ma

jori

ty d

o n

ot

rep

ort

th

ey

use

th

e in

form

atio

n t

o d

ete

rmin

e c

on

trib

utio

n.

So

me

st

ate

cle

arl

y th

ey

revi

ew

th

e d

ata

an

d t

ry t

o a

sse

ss c

on

trib

utio

n e

ffe

cts.

Ho

we

ver,

of

the

se a

sm

all

min

ori

ty s

ay

the

y O

NL

Y lo

ok

at

the

stu

de

nt’s

ro

le in

th

e e

ven

t. M

ost

d

esc

rib

e a

sys

tem

sim

ilar

to t

he

“h

ud

dle

”, w

he

re t

he

stu

de

nt

an

d c

linic

al s

up

erv

iso

r w

ou

ld r

evi

ew

th

e e

ven

t to

de

term

ine

ca

use

. T

he

re

vie

w w

ou

ld n

ot

go

an

y fu

rth

er.

57

Fre

qu

en

cy

Dis

trib

uti

on

o

f S

ca

le R

es

po

ns

es

T

oo

l It

em

1

2

3

4

5

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

2.

Th

ere

is

a

pro

ce

ss

fo

r re

me

dia

tio

n (

e.g

.,

cli

nic

al

lea

rnin

g

co

ntr

ac

t; c

lin

ica

l o

r p

erf

orm

an

ce

im

pro

ve

me

nt

pla

n)

wh

en

re

vie

w o

f a

c

los

e c

all

or

ad

ve

rse

ev

en

t s

ug

ge

sts

th

at

the

re

is/a

re s

ign

ific

an

t s

tud

en

t p

erf

orm

an

ce

is

su

e(s

) th

at

co

ntr

ibu

ted

to

th

e

ev

en

t

0

0

0

17

1

Le

arn

ing

co

ntr

act

s a

re u

sed

by

mo

st o

f th

e p

rog

ram

s th

at

ela

bo

rate

d o

n t

his

ite

m a

s a

p

roce

ss f

or

rem

ed

iatio

n.

Ve

ry f

ew

re

po

rte

d u

sin

g s

pe

cia

l ass

ign

me

nts

or

sim

ply

“h

avi

ng

po

licie

s in

pla

ce”.

3.

Info

rma

tio

n

ob

tain

ed

th

rou

gh

th

es

e p

roc

es

se

s i

s

ag

gre

ga

ted

in

a w

ay

th

at

pro

tec

ts

an

on

ym

ity

, a

nd

is

u

se

d t

o i

de

nti

fy

op

po

rtu

nit

ies

to

im

pro

ve

th

e

ed

uc

ati

on

pro

gra

m

5

1

2

8

2

Of

tho

se w

ho

co

mm

en

ted

on

th

is t

ime

, th

e m

ajo

rity

of

inst

itutio

ns

are

no

t u

sin

g

ag

gre

ga

ted

da

ta t

o id

en

tify

op

po

rtu

niti

es

to im

pro

ve.

Mo

st a

re a

t th

e s

tag

e o

f tr

yin

g t

o

ge

t th

e s

pe

cific

info

rma

tion

an

d le

arn

info

rma

lly t

hro

ug

h d

iffe

ren

t p

roce

sse

s w

hile

at

the

sa

me

tim

e p

rote

ctin

g t

he

stu

de

nt’s

ide

ntit

y. T

he

re s

ee

m t

o b

e m

an

y in

tern

al p

roce

sse

s w

he

n e

ven

ts h

ave

ha

pp

en

ed

, h

ow

eve

r, w

he

re t

he

sp

eci

fic in

form

atio

n m

ay

be

sh

are

d

to b

ett

er

un

de

rsta

nd

wh

y th

e e

ven

t h

ap

pe

ne

d.

Th

ese

lea

rnin

gs

do

no

t e

xte

nd

to

a

syst

em

atic

pro

cess

fo

r le

arn

ing

an

d im

pro

vin

g t

he

pro

gra

m.

58

Fre

qu

en

cy

Dis

trib

uti

on

o

f S

ca

le R

es

po

ns

es

T

oo

l It

em

1

2

3

4

5

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

4.

A r

ep

ort

ing

s

ys

tem

is

in

pla

ce

to

g

ath

er

info

rma

tio

n

ab

ou

t c

los

e c

all

s

an

d/o

r a

dv

ers

e

ev

en

ts i

n w

hic

h

stu

de

nts

are

in

vo

lve

d w

hil

e t

he

y

are

in

p

rac

tic

e/c

lin

ica

l le

arn

ing

sit

ua

tio

ns

4

0

0

10

4

Ove

rall,

str

uct

ure

d,

syst

em

atic

re

po

rtin

g s

yste

ms

for

ad

vers

e e

ven

ts a

re n

ot

in p

lace

. M

ost

of

the

re

spo

nd

en

ts f

or

this

ite

m in

dic

ate

d t

ha

t th

ey

use

stu

de

nt

eva

lua

tion

s,

inci

de

nt

rep

ort

s a

nd

ve

rba

l fe

ed

ba

ck a

bo

ut

ad

vers

e e

ven

ts.

Mo

re t

ha

n h

alf

of

the

re

spo

nd

en

ts in

dic

ate

d t

he

y d

o n

ot

ha

ve a

cce

ss t

o a

ny

da

ta.

So

me

of

this

is d

ue

to

an

in

form

atio

n b

arr

ier

be

twe

en

th

e c

linic

al s

ett

ing

an

d e

du

catio

na

l pro

gra

m.

5.

Th

e s

tud

en

t d

ata

c

oll

ec

ted

th

rou

gh

a

ny

in

cid

en

t re

po

rtin

g s

ys

tem

in

p

lac

e i

n t

he

cli

nic

al

pra

cti

ce

se

ttin

g (

5

ab

ov

e)

is r

ou

tin

ely

s

ha

red

wit

h t

he

e

du

ca

tio

n p

rog

ram

, a

nd

us

ed

to

id

en

tify

o

pp

ort

un

itie

s t

o

imp

rov

e t

he

e

du

ca

tio

n p

rog

ram

6

0

3

7

2

In g

en

era

l, th

ere

is n

o s

yste

ma

tic,

rou

tine

sh

ari

ng

of

da

ta b

etw

ee

n t

he

clin

ica

l se

ttin

g

an

d t

he

ed

uca

tion

al i

nst

itutio

ns.

Wh

en

da

ta is

sh

are

d,

it is

mo

stly

ve

rba

l co

mm

un

ica

tion

initi

ate

d b

y a

clin

ica

l su

pe

rvis

or

wh

o d

eci

de

s th

at

the

ed

uca

tion

p

rog

ram

sh

ou

ld b

e a

wa

re o

f a

pa

rtic

ula

r e

ven

t o

r cl

ose

ca

ll.

Th

ere

is e

vid

en

ce t

ha

t so

me

of

the

pro

gra

ms

inte

rpre

t th

e le

arn

ing

op

po

rtu

niti

es

at

the

in

div

idu

al l

eve

l, n

ot

at

a s

yste

m le

vel:

“I g

ue

ss,

if w

e d

isco

ver

tha

t st

ud

en

ts d

id

som

eth

ing

inco

rre

ctly

in t

he

fie

ld a

nd

th

is w

as

be

cau

se w

e t

au

gh

t so

me

thin

g in

corr

ect

ly

we

wo

uld

ad

just

it”.

59

Fre

qu

en

cy

Dis

trib

uti

on

o

f S

ca

le R

es

po

ns

es

T

oo

l It

em

1

2

3

4

5

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

6.

A f

air

an

d j

us

t p

roc

es

s i

s i

n p

lac

e

to s

up

po

rt s

tud

en

ts

wh

o a

re i

nv

olv

ed

in

a

n a

dv

ers

e e

ve

nt

du

rin

g a

c

lin

ica

l/p

rac

tic

al

lea

rnin

g e

xp

eri

en

ce

1

0

1

14

2

A

cco

rdin

g t

o t

he

re

spo

nd

en

ts t

o t

his

qu

est

ion

, m

ost

inst

itutio

ns

do

no

t h

ave

a f

orm

al

pro

cess

in p

lace

. T

he

y se

e t

he

ir s

up

po

rt b

ein

g e

xte

nd

ed

to

th

e s

tud

en

t th

rou

gh

ca

rin

g

sta

ff a

nd

su

pe

rvis

ors

, a

nd

th

ey

tru

st t

he

y a

re ju

st a

nd

fa

ir in

th

eir

inte

ract

ion

with

th

e

stu

de

nt.

So

me

su

gg

est

ed

th

ey

do

no

t lo

ok

at

the

se e

ven

ts a

s st

ud

en

t sp

eci

fic,

bu

t th

ey

att

em

pt

to a

dd

ress

th

e b

roa

de

r a

spe

cts

“We

ha

ve a

co

nst

ruct

ive

ap

pro

ach

to

ad

dre

ssin

g t

he

se

issu

es;

we

loo

k fo

r p

att

ern

s –

no

t in

div

idu

als

”.

7.

A f

air

an

d j

us

t p

roc

es

s i

s i

n p

lac

e

to s

up

po

rt c

lin

ica

l in

str

uc

tors

/pre

ce

pto

rs w

ho

are

in

vo

lve

d

in a

n a

dv

ers

e e

ve

nt

wit

h a

stu

de

nt

du

rin

g a

c

lin

ica

l/p

rac

tic

al

lea

rnin

g e

xp

eri

en

ce

3

0

2

10

3

H

alf

of

resp

on

de

nts

to

th

is it

em

re

cog

niz

ed

th

ey

ha

ve a

fa

ir a

nd

just

pro

cess

in p

lace

to

su

pp

ort

clin

ica

l in

stru

cto

rs a

nd

pre

cep

tors

.

So

me

of

the

re

spo

nd

en

ts in

dic

ate

d t

ha

t th

e s

up

po

rt o

f p

rece

pto

rs a

nd

clin

ica

l sta

ff is

re

ally

ou

t o

f th

eir

co

ntr

ol.

“Ou

r co

llect

ive

an

swe

r is

ye

s it

is d

on

e t

hro

ug

h A

HS

– b

ut

we

d

on

’t kn

ow

”.

Th

e s

am

e g

rou

p in

dic

ate

d t

he

y p

rovi

de

su

pp

ort

to

th

e c

linic

al i

nst

ruct

ors

, h

ow

eve

r,

the

re is

litt

le e

vid

en

ce t

ha

t th

e s

up

po

rt is

pro

vid

ed

in a

ny

stru

ctu

red

or

syst

em

atic

wa

y.

It is

mo

re d

esc

rib

ed

as

a s

up

po

rtiv

e e

nvi

ron

me

nt

wh

ere

clin

ica

l in

stru

cto

rs a

nd

p

rece

pto

rs c

an

sh

are

/dis

cuss

th

e e

xpe

rie

nce

with

ou

t b

ein

g ju

dg

ed

. “W

e w

ou

ld s

up

po

rt

the

su

pe

rvis

or

of

the

stu

de

nt

in a

ny

wa

y w

e c

ou

ld –

bu

t w

e d

on

’t h

ave

a s

tru

ctu

red

p

roce

ss t

o d

o t

his

”.

60

Fre

qu

en

cy

Dis

trib

uti

on

o

f S

ca

le R

es

po

ns

es

T

oo

l It

em

1

2

3

4

5

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

8.

Ap

pro

pri

ate

e

mo

tio

na

l s

up

po

rt

is p

rov

ide

d t

o b

oth

s

tud

en

ts a

nd

th

eir

c

lin

ica

l in

str

uc

tors

/pre

ce

pto

rs w

ho

are

in

vo

lve

d

in a

dv

ers

e e

ve

nts

th

at

res

ult

in

pa

tie

nt

ha

rm t

o h

elp

th

em

c

op

e w

ith

th

e

sit

ua

tio

n

1

1

8

10

2

O

vera

ll, t

he

pro

gra

ms

reco

gn

ize

d t

he

ne

ed

to

pro

vid

e s

up

po

rt t

o s

tud

en

ts in

ca

ses

of

ad

vers

e e

ven

ts.

Su

pp

ort

is o

ffe

red

th

rou

gh

co

un

selli

ng

, st

aff

be

ing

ava

ilab

le t

o t

ake

ca

lls,

de

bri

efin

g e

tc.

“Stu

de

nts

ha

ve a

cce

ss t

o d

eb

rie

f if

an

yth

ing

ha

pp

en

s. C

an

als

o

tele

ph

on

e a

nd

em

ail

as

we

ll a

s th

e c

ou

nse

llor

tra

vel t

o s

ite”.

So

me

re

spo

nd

en

ts in

dic

ate

d t

he

y d

o n

ot

ha

ve a

nyt

hin

g f

orm

al i

n p

lace

, b

ut

sup

po

rt is

a

vaila

ble

on

an

ad

ho

c b

asi

s d

ep

en

din

g o

n t

he

eve

nt

tha

t h

as

occ

urr

ed

. T

he

y a

lso

su

gg

est

ed

it is

ve

ry r

are

th

at

such

eve

nts

occ

ur.

Fin

ally

, so

me

als

o r

eco

gn

ize

d t

ha

t cl

inic

al i

nst

ruct

ors

ne

ed

to

be

su

pp

ort

ed

as

we

ll.

Pre

cep

tors

, o

n t

he

oth

er

ha

nd

, a

re e

xpe

cte

d t

o u

se t

he

ir o

wn

em

plo

yer

syst

em

fo

r su

pp

ort

.

Sp

ec

ify

an

y o

the

r o

f y

ou

r p

rog

ram

p

roc

es

se

s,

rela

ted

to

re

sp

on

din

g t

o

clo

se

ca

lls

an

d

ad

ve

rse

ev

en

ts

inv

olv

ing

stu

de

nts

, th

at

are

no

t li

ste

d

ab

ov

e

S

om

e a

dd

itio

na

l to

pic

s m

en

tion

ed

by

resp

on

de

nts

to

th

is q

ue

stio

n w

ere

:

• L

ab

se

ttin

gs

• W

CB

•

Sh

ou

ld id

en

tify

spe

cific

re

sou

rce

s a

vaila

ble

with

in in

stitu

tion

su

ch a

s o

mb

ud

spe

rso

n,

OH

S e

tc

• A

sk e

ach

clin

ica

l in

stitu

tion

ab

ou

t th

e r

ep

ort

ing

sys

tem

in t

he

ir a

ge

ncy

. •

Clin

ica

l se

ttin

gs

ne

ed

to

se

e t

his

fro

m a

sys

tem

s p

ers

pe

ctiv

e.

Th

ey

do

no

t e

mb

race

th

e s

yste

m a

pp

roa

ch –

th

ey

focu

s o

n t

he

stu

de

nt.

“B

lam

e a

nd

sh

am

e

cultu

re s

till p

reva

len

t. V

ery

diff

icu

lt to

ch

an

ge

”.

• T

he

ite

ms

sho

uld

fo

cus

on

pre

ven

ting

inci

de

nce

s n

ot

just

re

spo

nd

ing

aft

er

the

fa

ct.

• T

he

re is

an

ass

um

ptio

n t

ha

t it

is t

he

pa

tien

t th

at

is h

arm

ed

. It

is m

ore

co

mm

on

th

at

the

stu

de

nt

is h

arm

ed

. S

ho

uld

be

ite

ms

rela

ted

to

th

is.

61

Fre

qu

en

cy

Dis

trib

uti

on

o

f S

ca

le R

es

po

ns

es

T

oo

l It

em

1

2

3

4

5

Inc

orp

ora

tio

n o

f P

ati

en

t S

afe

ty E

du

ca

tio

n i

n C

urr

icu

lum

Are

all

th

es

e

qu

es

tio

ns

im

po

rta

nt?

A

ll o

f th

e p

rog

ram

s re

spo

nd

ed

th

at

the

se q

ue

stio

ns

are

imp

ort

an

t.

Are

th

ere

im

po

rta

nt

qu

es

tio

n m

iss

ing

?

M

ost

fo

un

d it

ha

rd t

o id

en

tify

wh

at,

if a

nyt

hin

g,

wa

s m

issi

ng

.

Se

vera

l no

ted

ho

w h

elp

ful t

he

to

ol h

ad

be

en

in id

en

tifyi

ng

ke

y a

rea

s fo

r p

atie

nt

safe

ty

an

d it

allo

we

d t

he

pro

gra

m t

o s

ee

wh

ere

th

ey

cou

ld d

o a

dd

itio

na

l wo

rk t

o im

pro

ve t

he

ir

pro

gra

m.

So

me

su

gg

est

ion

s w

ere

:

So

me

thin

g a

bo

ut

a p

ers

on

th

at

is o

bst

ruct

ive

to

th

is p

roce

ss –

so

me

qu

est

ion

to

ca

ptu

re t

his

. If

th

is is

go

ing

into

a c

urr

icu

lum

ba

se –

th

en

th

ere

ha

s to

be

so

me

co

nse

qu

en

ces

bro

ug

ht

forw

ard

– r

ule

s a

nd

re

gu

latio

ns.

Are

co

nse

qu

en

ces

ou

tlin

ed

fo

r yo

ur

stu

de

nts

in t

he

eve

nt

of

ad

vers

e e

ven

t?

Ne

ed

to

incl

ud

e q

ue

stio

ns

rela

ted

to

th

e p

riva

te p

rog

ram

s –

are

th

ey

pro

vid

ing

WC

B t

o

the

ir s

tud

en

t? T

he

re a

re in

cid

en

ces

ea

ch y

ea

r. T

his

wo

uld

he

lp t

o a

dvo

cate

fo

r th

e

stu

de

nts

.

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