"Everyone is in
favor of safety. What we really need is a set of concrete specific goals to
move things along."
— Lucian Leape, MD, to the Boston Globe
Set objectives that are specific and evidence-based
Don’t wait for an adverse event before taking action to
improve the safe delivery of care. Patient safety is a continuous process. Your plan will be more successful if it includes specific goals that everyone in the organization can work toward.
Examine systems, processes, and the environment and recognize potential safety issues. Think about what could go wrong and prevent it before it happens.
Some ways to get started include:
Asking staff “What keeps you awake at night?” when it comes to the safety of patients and colleagues.
Share letters from patients and families with positive and negative comments about the care they received at your facility.
Reach out to patients and families while they are at your facility for an appointment. For example, if patients are given an ID bracelet at check-in, the patient is a good source of information about whether or not your frontline providers are checking ID bracelets before administering tests or starting procedures.
Have group conversations about what changes to your practices’ way of doing things might prevent harm from happening.
Analyze the change possibilities and identify those you think are most likely to help.
Don’t be daunted by the number of things you might want or need to change. Ask – what change can you try next Tuesday?
To keep the scope manageable, consider trying the change in one small area first. For example, if you are worried that the written instructions you give patients for home care are not clear, start by re-writing just one set of instructions. Try it with a handful of patients, revise it, then work to improve written instructions for after-care related to another procedure.
Collect information about what is going wrong and why the problem is happening. Use a tool such as a flowchart to guide the process. This approach helps you to map out the steps involved in care and find potential areas of improvement.
Pick specific goals that allow you to track your progress.
For example, rather than “increase reporting of laboratory test results,” set a target – such as “over the next six months, 90% of laboratory test results will be shared with both the primary care provider and patient within 48 hours.”
For example, the target number of laboratory test results shared within 48 hours with the primary care provider and patient for the new year may be a certain percentage higher than the previous year.
Look to professional organizations and other health care institutions for benchmarks.
For example, if you are a long-term care facility, use Medicare’s Nursing Home Compare tool to look at staff influenza vaccination rates for peer facilities and set a goal to move your staff’s compliance to the top of the list.
Depending on your setting, you could start by looking at: medication management, latex exposure, blood glucose monitoring and testing, hand hygiene, communicating laboratory test results, patient identification, mental health, and so on.
Review the examples of patient safety measures below as a starting point. Then determine appropriate objectives for your organization. Think about processes, equipment, communication, specific patient groups and diagnoses, and so on.
As you review each example, make a list of the ones most appropriate to your practice:
National Patient Safety Goals from the Joint Commission: these goals are available for ambulatory care, behavioral health, home care, and hospitals in both easy-to-read summaries and detailed chapters.
Patient Safety Indicators from the Agency for Healthcare Research and Quality: this piece outlines provider- and area-level measures for hospitals and includes a link to more detailed indicators.
