What's next for patient safety? A focus on 'people, process, and practices,' experts say

It is time to move beyond structural and technical improvements in patient safety, experts say

Editor's note: This story was updated on June 25, 2018.

Care teams need to move beyond traditional process-improvement paradigms to achieve the next generation of safety improvements, a group of researchers write for Harvard Business Review.

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The surgical community's focus on structural and technical improvements, such as process standardization and minimally invasive surgeries, has led to significant improvements in patient safety, write Amir Ghaferi of the University of Michigan and Christopher Myers, Kathleen Sutcliffe, and Peter Pronovost of  Johns Hopkins University.

But they say making further major strides will require providers to turn their attention toward so-called "high-reliability organizing": the interpersonal mechanics of how providers work together to solve problems and respond to errors.

High-reliability organizing

Unlike clinical standardization, high-reliability organizing embraces complexity and recognizes that each patient is unique. What matters is how groups of providers work together to deal with that complexity, the researchers write. "Organizing for high reliability involves attending to not only the culture of a surgical team or health care organization (i.e., their shared values and beliefs), but also to the actual behaviors, practices, and interactions that unfold between people as they care for patients and manage the organization," the researchers explain.  

For example, standardization and technical improvements may reduce the chances of medical errors occurring in the first place, but high-reliability organizing can improve outcomes after a complication has occurred by influencing how a care team reacts.

"In other words," the researchers write, "it isn't only about standardizing or improving techniques to reduce complications, but it is also about how health care providers organize their work so that they recognize when something is going wrong (before it has already gone wrong) and can adapt to rescue patients."

In the field

Johns Hopkins Medicine, for instance, has developed a comprehensive unit-based safety program (CUSP) that trains frontline staff on how to improve their teamwork, knowledge-sharing, learning, and communication. According to the researchers, CUSP has led to a 33 percent reduction in surgical site infections among colorectal surgery teams.

Ghaferi and colleagues also note that a study of nearly 1,700 nurses at 10 hospitals by Vanderbilt University researchers found "that more mindful organizing processes among nurses in a unit (e.g., being attentive to mistakes and how to learn from them, and relying on the team's pool of expertise, rather than hierarchical leaders, to resolve issues) was associated with significantly fewer medication errors and patient falls in that unit."

Ghaferi and colleagues acknowledge that "safe and highly reliable patient care is the ultimate target of any improvement effort." But  they conclude, "Identifying future levers for improving health care and patient safety will require a stronger focus on how people, process, and practice come together in patient care, rather than solely on technical or structural innovations" (Ghaferi et al., Harvard Business Review, 8/8).

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