"Chance Favors Only the Prepared Mind": Preparing Minds to Systematically Reduce Hazards in the Testing Process in Primary Care
Testing plays a vital role in primary care. Failures in the process are common and can be harmful. As the great 19th century microbiologist Louis Pasteur put it "chance favors only the prepared mind." Our objective is to prepare minds in primary care practices to improve safety in the testing process. Various principles from safety science can be applied.
A prospective methodology that uses an anonymous practice survey based on concepts from failure modes and effects analysis is proposed. Responses are used to rank perceived hazards in the testing process, leading to prioritization of areas for intervention. Secondary data analysis (using data from a study of medication safety) was used to explore the value of this approach in the context of assessing the testing process.
At 3 primary care practice sites, a total of 61 staff members completed 4 survey items examining the testing process. Comparison across practices shows that each has a distinct profile of hazards, which would lead each on a different path toward improvement.
The proposed approach treats each practice as a unique complex adaptive system aiming to help it thrive by inculcating trust, mutual respect, and collaboration. Implications for patient safety research and practice are discussed.
Available from: Ranjit Singh
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ABSTRACT: The author asks for the attention of leaders and all other stakeholders to calls of the World Health Organization (WHO), the Institute of Medicine (IOM), and the UK National Health Service (NHS) to promote continuous learning to reduce harm to patients. This paper presents a concept for structured bottom-up methodology that enables and empowers all stakeholders to identify, prioritize, and address safety challenges. This methodology takes advantage of the memory of the experiences of all persons involved in providing care. It respects and responds to the uniqueness of each setting by empowering and motivating all team members to commit to harm reduction. It is based on previously published work on “Best Practices Research (BPR)” and on “Systematic Appraisal of Risk and Its Management for Error Reduction (SARAIMER)”. The latter approach, has been shown by the author (with
Agency for Healthcare Research and Quality (AHRQ) support), to reduce adverse events and their severity through empowerment, ownership and work satisfaction. The author puts forward a strategy for leaders to implement, in response to national and international calls for Better health, Better care, and Better value (the 3B’s of healthcare) in the US
Patient Protection and Affordable Care Act.
This is designed to enable and implement “
A promise to learn- a commitment to act”. AHRQ has recently published “A Toolkit for Rapid-Cycle Patient Safety and Quality Improvement” that includes an
adapted version of SARAIMER.
Available from: Penny Rhodes
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ABSTRACT: IntroductionPatient safety research has tended to focus on hospital settings, although most clinical encounters occur in primary care, and to emphasize practitioner errors, rather than patients' own understandings of safety.Objective
To explore patients' understandings of safety in primary care.Methods
Qualitative interviews were conducted with patients recruited from general practices in northwest England. Participants were asked basic socio-demographic information; thereafter, topics were largely introduced by interviewees themselves. Transcripts were coded and analysed using NVivo10 (qualitative data software), following a process of constant comparison.ResultsThirty-eight people (14 men, 24 women) from 19 general practices in rural, small town and city locations were interviewed. Many of their concerns (about access, length of consultation, relationship continuity) have been discussed in terms of quality, but, in the interviews, were raised as matters of safety. Three broad themes were identified: (i) trust and psycho-social aspects of professional–patient relationships; (ii) choice, continuity, access, and the temporal underpinnings of safety; and (iii) organizational and systems-level tensions constraining safety.DiscussionConceptualizations of safety included common reliance on a bureaucratic framework of accreditation, accountability, procedural rules and regulation, but were also individual and context-dependent. For patients, safety is not just a property of systems, but personal and contingent and is realized in the interaction between doctor and patient. However, it is the systems approach that has dominated safety thinking, and patients' individualistic and relational conceptualizations are poorly accommodated within current service organization.
Available from: Paul Bowie
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ABSTRACT: Objectives To analyse a medical protection organisation's database to identify hazards related to general practice systems for ordering laboratory tests, managing test results and communicating test result outcomes to patients. To integrate these data with other published evidence sources to inform design of a systems-based conceptual model of related hazards.
Design A retrospective database analysis.
Setting General practices in the UK and Ireland.
Participants 778 UK and Ireland general practices participating in a medical protection organisation's clinical risk self-assessment (CRSA) programme from January 2008 to December 2014.
Main outcome measures Proportion of practices with system risks; categorisation of identified hazards; most frequently occurring hazards; development of a conceptual model of hazards; and potential impacts on health, well-being and organisational performance.
Results CRSA visits were undertaken to 778 UK and Ireland general practices of which a range of systems hazards were recorded across the laboratory test ordering and results management systems in 647 practices (83.2%). A total of 45 discrete hazard categories were identified with a mean of 3.6 per practice (SD=1.94). The most frequently occurring hazard was the inadequate process for matching test requests and results received (n=350, 54.1%). Of the 1604 instances where hazards were recorded, the most frequent was at the ‘postanalytical test stage’ (n=702, 43.8%), followed closely by ‘communication outcomes issues’ (n=628, 39.1%).
Conclusions Based on arguably the largest data set currently available on the subject matter, our study findings shed new light on the scale and nature of hazards related to test results handling systems, which can inform future efforts to research and improve the design and reliability of these systems.
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