Process optimisation and standardisation | No articulated processes. Transfers between professionals/processes are ad hoc and therefore error-prone. Lack of routine and lack of experience.
| Protocols available for essential processes. There is vigilance and a focus on individual discipline. Checklists for processes used by individuals.
| Decision aids, alarms and reminders built into the care-delivery processes. Desirable outcome is the default modus. Process standardisation and collective checklists lead to complexity reduction.
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Outcome measurement and monitoring | | Registration of adverse events but no insight into trends. Some process or outcome indicators are monitored, but there is no benchmarking. At best, the focus is on mediocre performance elsewhere. Quality monitoring is not part of the planning and control cycles.
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Responsibilities and accountability of medical professionals | | Limited individual autonomy. Individual medical professional is responsible for quality and safety of care. Overall control of safety by introduction of meetings, norms and limits.
| | Teams with situational awareness. Very strict control, but at the same time large responsibilities delegated to the ‘front-line’ (decentralised).
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Organisational culture | No explicit focus on patient safety. Taking risks is equal to high status. Absence of self-critical attitude; ‘denial of vulnerability.’ Learning by doing.
| | ‘Zero-tolerance’ for violating standards. Teams in which individual performance is of minor importance compared with overall performance. Collective drive to achieve a high-quality and safe environment. Safe introduction of new techniques.
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