framing and measuring patient safety dr jeanette jackson ([email protected])[email protected]...
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Framing and Measuring Patient Safety
Dr Jeanette Jackson
This SPSRN work is funded by
Outline
Introduction
Objectives
Framing Patient Safety Research
1. Examples of Industry Models for Safety Research
2. Examples of Patient Safety Models
3. Multilevel Framework of Patient Safety Research
Measuring Patient Safety Research
Introduction
• Effective management of patient safety in healthcare requires:
1. an understanding of the causes of adverse events and related outcomes
2. a capacity to measure adverse events and their causes as well as related outcomes at different levels (individual, unit, organization, industry, national, international)
• Measurement of industry safety status is achieved by a range of methods based on key performance indicators for risk factors and safety events as well as leading indicators for safety (including causes like cultural factors)
Objectives
1. To propose a causal framework for patient safety outcomes
2. To review possible methods for the relevant variables in each component of the framework with particular reference to acute hospitals
Framing Patient Safety Research
Examples of Industry Models for Safety Research:
1) ‘Swiss Cheese’ model of accident causation (Reason, 1997)
DANGERSome ‘holes’due to active
failures
Other ‘holes’due to latent conditions
Defences in depth
DANGERDANGERSome ‘holes’due to active
failures
Other ‘holes’due to latent conditions
Defences in depth
Framing Patient Safety Research
Examples of Industry Models for Safety Research:
1) ‘Swiss Cheese’ model of accident causation (Reason, 1997)
2) Vincent et al. (2000): Reason’s model within the healthcare setting
Framing Patient Safety Research
Examples of Industry Models for Safety Research:
1) ‘Swiss Cheese’ model of accident causation (Reason, 1997)
2) Vincent et al. (2000): Reason’s model within the healthcare setting
3) Factors influencing safety behaviours and safety outcomes at different levels of analysis (Flin, in prep)
External Influences
Organization Intervening Behaviours Outcomes
National Culture
Economic
Regulator
Government Targets
Safety Culture
Leadership
HR Practices
Safety ManagementPractices
Motivation
Wellbeing Morale
Knowledge
Safe
Compliance
Reporting
Speaking Up
Unsafe
Risk taking
Risk breaking
Plant/Worker Safety
Patient Safety
Framing Patient Safety Research
3) Factors influencing safety behaviours and safety outcomes at different levels of analysis (Flin, in prep)
Framing Patient Safety Research
Examples of Industry Models for Safety Research:
1) ‘Swiss Cheese’ model of accident causation (Reason, 1997)
2) Vincent et al. (2000): Reason’s model within the healthcare setting
3) Factors influencing safety behaviours and safety outcomes at different levels of analysis (Flin, in prep)
4) Threat and Error model (Helmreich, 2000)
Framing Patient Safety Research
4) Threat and Error model (Helmreich, 2000)
Framing Patient Safety Research
Examples of Patient Safety Models:
1) Generic Reference Model (GRM, Runciman et al., 2006)
Framing Patient Safety Research
Examples of Patient Safety Models:
1) Generic Reference Model (GRM, Runciman et al., 2006)
2) Conceptual Framework for the International Classification for Patient Safety (ICPS, WHO Drafting Group of the Project to Develop the International Classification for Patient Safety, 2008)
Contributing Factors/Hazards
Patient Characteristics
Ameliorating Actions
System Resilience (Proactive & Reactive Risk Assessment)
Clinically meaningful, recognizable categories for incident identification & retrieval
Descriptive information
Organizational Outcomes
Detection
Mitigating Factors
Actions Taken to
Reduce Risk or Harm
Actio
ns
T
aken to
R
edu
ce R
isk or
Harm
Incident Characteristics
Patient Outcomes
IncidentIncident Type
Influences Informs
Influences
Influences
Informs
Informs
Informs Informs
Informs Informs
Framing Patient Safety Research
Examples of Patient Safety Models:
1) Generic Reference Model (GRM, Runciman et al., 2006)
2) Conceptual Framework for the International Classification for Patient Safety (ICPS, WHO Drafting Group of the Project to Develop the International Classification for Patient Safety, 2008)
3) Donabedian’s (1966) ‘triad’ of structure, process and outcome
4) Brown et al.’s (2008) adaptation of Donabedian’s ‘triad’
Framing Patient Safety Research
4) Brown et al.’s (2008) adaptation of Donabedian’s ‘triad’
Structure Patient OutcomesClinical Processes
- Error
Fidelity
Management Processes
Fidelity
Intervening Variables
e.g. morale, culture
Generic Intervention
Specific Intervention Throughput
Framing Patient Safety Research
Multilevel Framework of Patient Safety Research (Jackson & Flin, in prep):
Organizational Factors
Unit Management
WorkerBehaviours
Outcomes
Individual Differences
• Based on the causal chain and different levels of analysis (i.e., individual, team, unit, and organisational) proposed by industrial and patient safety models
• Applies within an organisation even though external factors such as government and regulators responsibilities exist outside an organisation
Measuring Patient Safety Research
Medical records
Incident reporting systems
Prospective analysis tools
Questionnaires
Direct observations and video techniques
Interviews
Simulations
Claims and complaints
Shift reporting
Autopsy reports
Checklists and audits
Measuring Patient Safety Research
Method
Component
Organizational Factors
Unit Management
Worker Behaviours
Individual Differences
Outcomes
Medical records
Questionnaires
Claims and Complaints
Measuring Patient Safety Research
Medical records
• ‘Triggers’ to measure patient harm to identify adverse events in medical records (Rozich et al., 2003)
Measuring Patient Safety Research
Method
ComponentOrganizational
FactorsUnit
ManagementWorker
BehavioursIndividual
DifferencesOutcomes
Medical records
x
Measuring Patient Safety Research
Medical records
• ‘Triggers’ to measure patient harm to identify adverse events in medical records (Rozich et al., 2003)
Questionnaires
• Provide information about people’s knowledge, beliefs, attitudes and behaviours
• Wide range of questionnaires including instruments measuring Safety Culture Safety improvement requires a culture of the healthcare system that is
not regarded as a potential risk factor threatening the patient
Measuring Patient Safety Research
Method
ComponentOrganizational
FactorsUnit
ManagementWorker
BehavioursIndividual
DifferencesOutcomes
Medical records
x
Questionnaires x x x x x
Measuring Patient Safety Research
Medical records
• ‘Triggers’ to measure patient harm to identify adverse events in medical records (Rozich et al., 2003)
Questionnaires
• Provide information about people’s knowledge, beliefs, attitudes and behaviours
• Wide range of questionnaires including instruments measuring Safety Culture Safety improvement requires a culture of the healthcare system that is
not regarded as a potential risk factor threatening the patient
Claims and complaints
• Incidence data, experience with intervention programmes, starting point for reviews of patient safety data and activities
Measuring Patient Safety Research
Method
Component
Organizational Factors
Unit Management
Worker Behaviours
Individual Differences
Outcomes
Medical records
x
Questionnaires x x x x x
Claims and Complaints
x x x
Organizational Factors: include stressors on the system Available resources (e.g., staffing, equipment) Responsibilities of the senior management (e.g., setting standards and goals within the organisation)
Unit Management: Wide range of behaviours that influence outcomes (e.g., planning, delegating, scheduling, providing training and supervision, leadership, communication, decision making)
Worker Behaviours: Reporting at unit / team level Safety participation / compliance at individual level Non-technical skills (e.g., teamwork, speaking up)
Outcomes: Wide range of outcomes affecting the patient (e.g., infections, surgical incidents, adverse drug events) and the worker (e.g., injuries)
Individual Differences: possible mediators e.g., motivation, knowledge, fatigue, burnout
Organizational Factors
Unit Management
WorkerBehaviours
Outcomes
Individual Differences
Method
ComponentOrganizational
FactorsUnit
ManagementWorker
BehavioursIndividual
DifferencesOutcomes
Incident reporting systems
Prospective analysis tools
Direct observations and video techniques
Interviews
Simulations
Shift reporting
Autopsy reports
Checklists and audits
Method
ComponentOrganizational
FactorsUnit
ManagementWorker
BehavioursIndividual
DifferencesOutcomes
Incident reporting systems
x x x
Prospective analysis tools
x x x x x
Direct observations and video techniques
x x x x x
Interviews x x x
Simulations x
Shift reporting x
Autopsy reports
x
Checklists and audits
x