Historically, change in healthcare has happened in a reactive, fragmented manner with each crisis that arises, as the primary driver for that change. A way of responding to the current changes occurring in healthcare is to consider every change an opportunity to influence the path an organisation desires to be on throughout their transformational journey.
Healthcare leaders are responsible to establish the path that their organisations will take, to that effect, one of the primary directives is to envision how patient safety will be in the future and how it will impact their respective organisation. In addition, they must foresee the changes needed between the present and the future in order for their vision to become reality.
With a macro-level view of where organisations need to strive to be, there are a number of initiatives that have to be undertaken in order for patient safety to not just be a priority, but to be a part of every moment that healthcare is delivered to a patient. These initiatives include:
A well-designed environment of healthcare delivery – needs to be safe, efficient, and designed to provide patients with healing aspects within the facility with advanced technologies that will support clinical care delivery. The environment will be safer by greater compliance with hand-hygiene guidelines, reduced patient falls and improved medication management. Construction materials need to be free of toxic materials and more effective in reducing contamination with infectious organisms. It is paramount that the development of this environment be throughout the organisation including the ambulatory setting.
The best way to ensure that the investments necessary for the development of these healthcare environments are commonplace, is the implementation of evidence-based design and the right investments for the organisational transformation. Likewise, there needs to be a revision of the usual accounting practices of separating operating and capital expenses, which make it difficult to implement strategies that optimise the life-cycle cost of a building.
Health Information Technology – provides a platform for healthcare organisations to establish solutions that will influence the speed and character of the technologic implementations. A direct interface between health information technology (HIT) and patient safety has been long established. This has evolved in the form of electronic medical records (EMRs), computerised physician order entry (CPOE), an electronic medication administration system (e-MAR) and electronic prescribing (eRx).
Four decades ago, the promise that HIT would make the delivery of healthcare safer, faster, better and more clinician friendly was a viable vision, yet, since that time our enthusiasm has stalled. In spite of the opportunities that HIT holds, we also have to be realistic of the difficulties in its interoperability, data standards and storage safety and how to best apply it for improving patient safety. Because we want HIT to provide us the long awaited and promised patient safety solutions, we often overlook the difficulties that technology amplifies or complicates. The IT industry needs to develop a digital infrastructure that provides healthcare organisations with data liquidity. This would allow for a common format that would support medical research, boost efficiency and improve patient safety.
A new collaborative relationship needs to develop between the companies that develop HIT systems and the global clinical community. Therefore, this new technology environment would keep patients safer and would ultimately promote the purchase of safer HIT systems that would be truly valuable to the transformation of healthcare organisations.
Patient-centred care – although many organisations around the world believe that they embody the definition of “patient-centred care” by delivering what patients say they want; it doesn’t completely represent safer care or the much broader concepts that “patient-centred care” embodies.
A model of co-creation and true partnership with patients is necessary to strengthen a culture of safety in a healthcare organisation. This relationship is based on mutual respect, trust, transparency, accountability and shared decision-making. This re-design of healthcare delivery will not just involve the patient and the healthcare team, but also take into account the patient’s perspective, thoughts, behaviour and of course participation. This new model can drive guidelines’ development, funding, solutions, ethical initiatives, research and policy development. All of these qualities of the healthcare delivery model will assure that the healthcare system is safe, compassionate, just and efficient.
A more comprehensive “patient-centred” programme needs to have a complete understanding of the dynamics of the communication of risk and the impact on patient engagement. In addition, a robust patient reporting system for medical errors, reengineering of safety solutions and best practices, with an unwavering support from executive leaders, will significantly contribute to patient safety.
Complex systems for the delivery of care – healthcare organisations must recognise that the delivery of clinical care is comprised of complex systems and, in order for an organisation to be able to transform itself, there needs to be a deep understanding of complex systems.
To be able to do this, clinicians, administrators and legislators have to consider the delivery of healthcare as a conglomerate of complex systems. These leaders must learn to have a “systems thinking” approach. This management style and thought process is necessary when designing and implementing evidence-based changes that are targeted toward reducing harm and improving safety for patients. This requires more than just adding new processes to an unchanged existing system. Often, it requires a system redesign to incorporate new functions in order to be efficient, reliable, effective and have sustainable changes.
There must be a prospective evaluation methodology based on a continuous vigilance, measuring processes and outcomes to identify early indicators of change. Once systems thinking has been implemented, clinical practice can become dramatically safer.