The path to safe and reliable healthcare

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Abstract

The ability to deliver safe and reliable healthcare is the goal of all healthcare delivery systems. To bridge the current performance gaps in quality and safety, organizations need to apply a systematic model that effectively addresses both culture and reliable processes of care. The model described in this article provides a comprehensive approach to improving the quality of care in any clinical domain. It also provides a roadmap for people working in clinical improvement to assess the strengths and current needs within their care systems, so they can be strategic and systematic in their work, essential elements for success. The concepts and tools provided can be readily applied to improve the quality and safety of care delivered.

Introduction

There are challenges to the successful delivery of safe, reliable healthcare that require different ways of thinking and learning. Healthcare economists speak of these challenges as the “perfect storm”—an aging healthcare workforce, an increasing demand of aging citizens requiring more complex care, and a financial cost of care that is increasingly difficult to sustain. These issues apply across the globe. The healthcare organizations and delivery systems that will be successful in this ever-changing care environment are applying a systematic approach to improve quality, safety and operational efficiency. Several components of this approach are discussed below.

Section snippets

Leadership at multiple levels of the organization

The teaching and modeling of effective leadership behaviors is essential within a high performing system. Senior leaders must be able to clearly articulate and message clear goals regarding organizational values and patient care.

An important insight from Thomas Krause's work in safety is the learning that the organizations leading in safety are also operationally efficient and cost effective. Based on Krause's extensive experience in multiple industries, the hallmarks of leaders whose

Safety culture

Culture has a profound impact on behavior and the ability to consistently deliver safe care. Safety culture lives at a clinical unit level and has to be measured as such. With more than six times more variation at the clinical unit level than at the hospital level, hospital level measurement will dilute out the profound insights that can be gleaned from the perceptions of the various caregivers in that particular unit. What is essential is to accurately reflect the various perceptions of

Human performance in a complex environment

The science of human factors relates to human performance in complex environments. In fact, a compelling argument can be made for effective teamwork in healthcare simply based on the complexity of the clinical environment. The work of Tucker and Spear observing nurses in a general ward environment found that during 8 hours of work nurses perform at least 100 different tasks lasting about 3 min each with frequent interruptions and distractions [3]. The human brain can remember five to seven items

Effective teamwork and communication

There are practical tools and behaviors to enhance effective teamwork and communication [6]. Communication failures are a central factor in the large majority of medical errors. There are four basic components of effective teamwork and communication: structured communication, effective assertion/critical language, psychological safety, and effective leadership behaviors.

Structured communication relates to tools like briefings, using checklists, situational briefing models like SBAR and

Patient and family centered care

Being a patient is a profound social experience. In order to deliver safe, high quality care, the care process needs to be designed around the needs of the patient, not the people providing care. There needs to be a fundamental understanding that patients and families will process the care experience socially, whereas many caregivers keep score technically—“we gave them the right medicine, did the correct procedure at the right time and they were still unhappy.” Knowing that patients and family

Reliable processes of care

To consistently provide consistent, high quality care, reliable processes are necessary to administer antibiotics in timely fashion, place central venous catheters safely, or respond to high-risk events like cardiac arrest. Given that medicine has been an art, with many skilled practitioners doing it “their way”, there has been lots of variation in the quality and consistency of care. Having reliable processes not only provides predictability in how the care will be delivered, but also provides

An environment of continuous learning and improvement

This is an area of fundamental need and opportunity within healthcare. Rarely are there effective mechanisms in place to capture information for front line providers as a source of consistent learning and improvement. Building in effective debriefing can be done in any care environment. The team can take 1 minute to debrief at the end of a shift, at the conclusion of a procedure or any clinical event. By making the debrief quick and efficient – asking the three questions previously mentioned –

Conclusion

In summary, what has been provided is a systematic framework containing the elements necessary for delivering safe and reliable care, while providing the opportunity to continually learn and improve the care process for both patients and the clinicians providing care.

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