Lessons Learned from a Systems Approach to Engaging Patients and Families in Patient Safety Transformation.

BACKGROUND: Effective patient- and family-centered care requires a dedication to engaging patients and family members in health system redesign to improve the quality, safety, and experience of care. Provided here are lessons learned six years after establishing an infrastructure of patient and family advisory councils (PFACs) focused on improving health care quality and safety. CONTEXT: A large regional health care system with multiple hospitals and ambulatory care delivery sites in the eastern United States adopted a systemwide approach to Patient and Family Advisory Councils on Quality and Safety (PFACQSⓇ) in 2012. APPROACH: This conceptual article describes the barriers and facilitators of adopting, implementing, and sustaining the PFACQS model across a large, geographically diffuse health system. Successful strategies that emerged include active board engagement, co-creation and mentorship by experienced patient advocates to support enhanced engagement by local PFACQS community members, and clear alignment with and line of sight on organizational quality and safety goals. CONCLUSION: Implementing a robust network of PFACQS focused on improving quality and patient safety requires leadership commitment to transparency, as well as mutual respect and trust. Establishing clear guidelines, structures, and processes supports early adoption. Openness to continuous improvement and adaptations are important to program success and contribute to program sustainability.

Patient safety: a consumer's perspective.

In this article we provide a reconceptualization of patient-centered health care practice through a collaborative person-centered model for enhanced patient safety. Twenty-one participants were selected and interviewed from the internationally diverse population of individuals attending the Chicago Patient Safety Workshop (CPSW) sponsored by Consumers Advancing Patient Safety (CAPS). Analysis of the participant transcripts revealed three findings related to patient experience: the impact and meaning of communication and relationship within the health care setting, trust and expectation for the patient and family with the health care provider, and the meaning and application of patient-centeredness. Researchers concluded that successful planning toward enhanced patient-centered care requires multiple perspectives, including the voices of the patient and family members who have experienced the trauma of preventable medical error. Collaborative initiatives such as the CPSW and CAPS offer a positive way forward for enhanced patient safety and quality of care.

Towards an International Classification for Patient Safety: the conceptual framework.

Global advances in patient safety have been hampered by the lack of a uniform classification of patient safety concepts. This is a significant barrier to developing strategies to reduce risk, performing evidence-based research and evaluating existing healthcare policies relevant to patient safety. Since 2005, the World Health Organization's World Alliance for Patient Safety has undertaken the Project to Develop an International Classification for Patient Safety (ICPS) to devise a classification which transforms patient safety information collected from disparate systems into a common format to facilitate aggregation, analysis and learning across disciplines, borders and time. A drafting group, comprised of experts from the fields of patient safety, classification theory, health informatics, consumer/patient advocacy, law and medicine, identified and defined key patient safety concepts and developed an internationally agreed conceptual framework for the ICPS based upon existing patient safety classifications. The conceptual framework was iteratively improved through technical expert meetings and a two-stage web-based modified Delphi survey of over 250 international experts. This work culminated in a conceptual framework consisting of ten high level classes: incident type, patient outcomes, patient characteristics, incident characteristics, contributing factors/hazards, organizational outcomes, detection, mitigating factors, ameliorating actions and actions taken to reduce risk. While the framework for the ICPS is in place, several challenges remain. Concepts need to be defined, guidance for using the classification needs to be provided, and further real-world testing needs to occur to progressively refine the ICPS to ensure it is fit for purpose.

The medical liability crisis of 2003: must we squander the chance to put patients first?

Medical liability reform should be aligned with a patient-centered, systems-based approach to preventing injury. Lessons learned about medical risk are now buried by the legal system, and communication about risk is haphazard among health care providers and across the interfaces of our legal, regulatory, and health care systems. Tort reform can be a vehicle for breaking down systemic barriers. Proposed reforms include (1) requiring disclosure of medical errors and restricting the use of information disclosed as evidence of guilt; (2) outlawing confidentiality agreements when malpractice cases are settled; (3) abolishing the National Practitioner Data Bank; and (4) establishing a national patient safety authority.

What is working in patient safety?

The authors discuss the purpose and themes of Partnership Symposium 2002: Smart Designs for Patient Safety, which was held in Washington, DC, October 14-16, 2002.

Ambulatory patient safety. What we know and need to know.

While safety risks are widespread in ambulatory settings, there has been insufficient attention directed at developing the evidence base that is needed to improve ambulatory safety. In this article, the current state of knowledge about ambulatory safety is reviewed. A research agenda in ambulatory safety is proposed, as well as a series of potential interventions that could be used to improve safety in the ambulatory setting.

Trial and error in my quest to be a partner in my health care: a patient's story.

A fearful stranger to the healthcare sector when she became a frequent user 2 years ago, Goeltz clearly is now a sophisticated and creative partner. She is fully engaged in decision-making and holds the decisions made as her own. Physicians often worry that their patients don't fully consent to the treatment given them because they don't fully understand the risks. This is often a factor in malpractice litigation. Goeltz's healers don't have that worry. When it comes to the complicated process of treatment, Goeltz doesn't take for granted that the system will operate optimally and holds herself accountable for doing what she can to deliver good outcomes for herself and her loved ones. She knows her active participation keeps the system safer. She challenges those she meets who want to discount her role and refuses to be treated by those who can't meet and adapt to those challenges. She has a lot to teach us all. The circumstances of my brother's death are what taught me the crucial importance of active participation in my own health care. The best tribute I can pay to him is to continue trying to show consumers and those in health care how they can partner with each other to truly improve safety. To those health care workers who are willing to work with me and put up with my challenging them from time to time, please accept my deepest gratitude. I would not be as healthy as I am today without you, and maybe I wouldn't even be alive. I know your jobs aren't easy, and you have earned my greatest respect.