Rethinking Patient Safety
At the beginning of this chapter we argued that the way we currently view patient safety assumes a generally high quality of healthcare punctuated by occasional safety incidents and adverse events. Increasingly we see this as a vision of safety from the perspective of healthcare professionals. This is a sincere vision in that professionals naturally assume that for the most part they are giving good care though they know that there are occasional lapses.
In contrast we have expanded our view of harm and recast patient safety as the examination of the totality of serious failures and harm within the patient journey which must necessarily be set against the benefits of the healthcare received. This is a vision of safety from the perspective of the patient, carer and family.
We believe that future progress in safety depends on conceptualizing safety in this broader manner and linking our understanding of safety with the wider ambitions and purposes of the healthcare system. This means viewing the risks and benefits of treatments over a longer timescale across different contexts and critically within the realities of a fragmented system with multiple vulnerabilities. This will require moving from a focus on specific errors and incidents to examining the origins of more fundamental failures of care such as avoidable hospitalisation due to undetected deterioration in a long term condition. The longer term aim both for patients and for patient safety is to consider how risk and harm can be minimised along the patient journey in pursuit of the optimum benefits from healthcare. In the following chapters we develop these ideas in more detail and consider how this ambitious, but we believe necessary, programme might be undertaken.
Key Points
• Patients have a different view of harm to professionals. Harm is conceived very broadly encompassing both serious disruption of treatment and lesser events that are more distressing than injurious.
• Harm for a patient includes serious failures to provide appropriate treatment as well as harm that occurs over and above the treatment provided. Both benefit and harm are seen not in terms of incidents but as a trajectory within a person's life.
• Many patient-identified events are not captured by the incident reporting system or recorded in the medical record.
• We propose that patient safety should focus on the totality of harm within the patient journey which must necessarily be set against the benefits of the healthcare received. This is a vision of safety from the perspective of the patient, carer and family.
• Patients and families will increasingly need to be actively involved in promoting safety. This can certainly bring benefits in terms of patient engagement and patient empowerment but also carries risks as patients shoulder the burden of organising and delivering care and the locus of medical error moves from professionals to patients and families.
• We need to view the risks and benefits of treatments over a longer timescale, across different contexts and within the realities of a fragmented system with multiple vulnerabilities. This will require moving from a focus on specific incidents to examining more fundamental longer term failures such as avoidable hospitalisation due to undetected deterioration in a chronic condition.
• We believe that future progress in safety depends on conceptualizing safety in this broader manner and linking our understanding of safety with the wider ambitions and purposes of the healthcare system.
References
Brady PW, Muething S, Kotagal U, Ashby M, Gallagher R, Hall D, Goodfriend M, White C, Bracke TM, DeCastro V, Geiser M, Simon J, Tucker KM, Olivea J, Conway PH, Wheeler DS (2013) Improving situation awareness to reduce unrecognized clinical deterioration and serious safety events. Pediatrics 131(1):e298–e308
Canfield C (2013) It's a matter of trust: a framework for patient harm. Unpublished manuscript. Stausberg J, Halim A, Färber R (2011) Concordance and robustness of quality indicator sets for hospi-
tals: an analysis of routine data. BMC Health Serv Res 11(1):106. doi:10.1186/1472-6963-11-106 Vincent C, Burnett S, Carthey J (2013) The measurement and monitoring of safety. Health
Foundation, London
Winterstein AG, Sauer BC, Hepler CD, Poole C (2002) Preventable drug-related hospital admissions. Ann Pharmacother 36(7–8):1238–1248
