Table 1

 Linkage of microsystem characteristics to patient safety

Microsystem characteristicsWhat this means for patient safety
LeadershipDefine the safety vision of the organisation
Identify the existing constraints within the organisation
Allocate resources for plan development, implementation, and ongoing monitoring and evaluation
Build in microsystems participation and input to plan development
Align organisational quality and safety goals
Engage the Board of Trustees in ongoing conversations about the organisational progress toward achieving safety goals
Recognition for prompt truth telling about errors or hazards
Certification of helpful changes to improve safety
Organisational supportWork with clinical microsystems to identify patient safety issues and make relevant local changes
Put the necessary resources and tools into the hands of individuals
Staff focusAssess current safety culture
Identify the gap between current culture and safety vision
Plan cultural interventions
Conduct periodic assessments of culture
Celebrate examples of desired behaviour—for example, acknowledgement of an error
Education and trainingDevelop patient safety curriculum
Provide training and education of key clinical and management leadership
Develop a core of people with patient safety skills who can work across microsystems as a resource
Interdependence of the care teamBuild plan–do–study–act (PDSA) into debriefings
Use daily huddles to debrief and to celebrate identifying errors
Patient focusEstablish patient and family partnerships
Support disclosure and truth around medical error
Community and market focusAnalyse safety issues in community and partner with external groups to reduce risk to population
Performance resultsDevelop key safety measures
Create feedback mechanisms to share results with microsystems
Process improvementIdentify patient safety priorities based on assessment of key safety measures
Address the work that will be required at the microsystem level
Information and information technologyEnhance error reporting systems
Build safety concepts into information flow (for example, checklists and reminder systems)