Transcript Key methodological steps and pitfalls in designing and

Framing and Measuring
Patient Safety
Dr Jeanette Jackson
([email protected])
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)
Some ‘holes’
due to active
failures
DANGER
Defences in
depth
Other ‘holes’
due to latent
conditions
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)
Framing Patient Safety Research
3) Factors influencing safety behaviours and safety outcomes at
different levels of analysis (Flin, in prep)
External
Influences
Organization
Behaviours
Safety Culture
Motivation
Safe
Leadership
Wellbeing
Compliance
HR Practices
Morale
Reporting
Safety Management
Practices
Knowledge
Speaking Up
National Culture
Economic
Regulator
Government Targets
Intervening
Outcomes
Plant/
Worker Safety
Unsafe
Risk taking
Risk breaking
Patient Safety
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)
Informs
Influences
Contributing Factors/Hazards
Patient
Characteristics
Incident
Characteristics
Informs
Detection
Influences
Informs
Mitigating Factors
Informs
Informs
Organizational
Outcomes
Patient
Outcomes
Informs
Informs
Ameliorating Actions
Actions
Taken to
Reduce
Risk or
Harm
System Resilience (Proactive & Reactive Risk Assessment)
Clinically meaningful, recognizable categories for incident identification & retrieval
Descriptive information
Actions Taken to Reduce Risk or Harm
Influences
Incident
Incident Type
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
Clinical Processes
- Error
Management
Processes
Patient Outcomes
Fidelity
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
Worker
Behaviours
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
Component
Method
Medical
records
Questionnaires
Claims and
Complaints
Organizational
Factors
Unit
Management
Worker
Behaviours
Individual
Differences
Outcomes
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
Component
Method
Medical
records
Organizational
Factors
Unit
Management
Worker
Behaviours
Individual
Differences
Outcomes
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
Component
Method
Organizational
Factors
Unit
Management
Worker
Behaviours
Individual
Differences
Medical
records
Questionnaires
Outcomes
x
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
Component
Method
Organizational
Factors
Unit
Management
Worker
Behaviours
Individual
Differences
Medical
records
Questionnaires
Claims and
Complaints
Outcomes
x
x
x
x
x
x
x
x
x
Any Questions?
Dr Jeanette Jackson
([email protected])
This SPSRN work is funded by
Exercise
Dr Jeanette Jackson
([email protected])
This SPSRN work is funded by
Organizational
Factors
Unit
Management
Worker
Behaviours
Outcomes
Individual
Differences
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
Component
Method
Incident
reporting
systems
Prospective
analysis tools
Direct
observations
and video
techniques
Interviews
Simulations
Shift reporting
Autopsy
reports
Checklists and
audits
Organizational
Factors
Unit
Management
Worker
Behaviours
Individual
Differences
Outcomes
Component
Method
Organizational
Factors
Unit
Management
Worker
Behaviours
Individual
Differences
x
Outcomes
Incident
reporting
systems
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
Checklists and
audits
x
x
x