Principles for Patient Safety

Teaching patient safety starts in medical school. Hospitals can be weired chaotic places. It’s often a wonder everything keeps working as it should although failures do occur. Medical professionals come to realize that mistakes happen and they adapt their working procedures to those of the so called high reliability organizations such as aircrafts, airline pilots, forest firefighting teams and trauma centers.

This change in mostly culture doesn’t go swiftly mostly with the excuse that their work is different from those organizations mentioned. Their work is incomparable to other organization which is not true, moreover some principles can easily be adapted to also work in health organizations such as hospitals.

Much work has to be done, but starting teaching about patient safety during medical education surely increases patient safety in the future.
Principles from high reliability organizations are:

  • Preoccupation with failures. Not only the big ones but also the small ones. These are often ignored and disregarded as variance.

    Consider the following: stretchers used for patient transport can occasionally have stuck wheels. Initially, this does not really affect the department as a whole because there are many stretchers. But if not addressed, the lack of stretchers over time can paralyze a department at the worst possible moment.

    Near misses are of much importance and response to these near failures often account for the culture of quality

  • Reluctance to oversimplify. Oversimplifying e.g. an X ray request with the drop down menu “Chest pain” can lead to clinical problems.

    With each cause of chest pain, there are different associations and recommendations that need to be made. Yet unless additional clinical points are also added to the requisition, the radiologist cannot render a more directed opinion.

  • Sensitivity to operation. Being aware of what is written down in standard operating procedures and what is done in real life can be two very different things. Organizations should always look for these differences, not only be aware of them.
  • Commitment to Resilience. Once a failure has happened, containing and limiting damage is required, and learning from mistakes is essential.
  • Deference to Local Expertise.

    In medicine, junior clinical or support staff members are frequently not comfortable voicing
    their concerns about situations or may be ignored by more senior staff members. Understanding these dynamics and talking about roles in advance may reduce power distance and improve quality of care.

    Prasanna, P., & Nagy, P. (2011). Learning From High-Reliability Organizations Journal of the American College of Radiology, 8 (10), 725-726 DOI: 10.1016/j.jacr.2011.06.020