Developing an effective patient safety policy
Developing an effective patient safety policy
Six principles to support patient safety initiatives
By Patrice Spath, RHIT
Brown-Spath Associates
Forest Grove, OR
Management’s declaration of a commitment to patient safety is an important element in the hospital’s patient safety improvement initiative. This declaration, or patient safety policy, establishes the set of principles by which management will put the commitment into practice. A well-thought-out patient safety policy establishes the basic philosophical foundation for specific actions that may be taken to improve patient safety. The preparation of a patient safety policy is a serious undertaking. To be useful, the policy statement must be effectively communicated. To ensure effective communication, management must understand the policy and its implications for the organization. For this reason, the policy should be homemade, developed by top administrative and physician leaders of the organization with input from middle managers and practicing physicians.
The health care organization’s patient safety policy is a commitment and principles document. It guides the behavior and decision making of people in the organization. The policy does not contain rules or procedures. The patient safety policy should not need many changes, whereas rules and procedures are subject to continual change as technology and processes change, as lessons are learned through patient incident investigations, and as new services are added.
Listed below are six general principles that have been found to be useful in supporting successful patient safety initiatives:
1. All iatrogenic patient injuries can be prevented. At first glance, this principle may appear overstated. Many people simply do not believe, upon initial reading, that the statement is correct. And yet, every sentinel event has causal factors that could have been avoided and underlying system failures that contributed to the likelihood of the event. The point of this principle is not that patient injuries will not occur, but simply that they can be (could have been) prevented. On the other hand, a statement that "all injuries must be prevented" is essentially useless. This dictum will not be fulfilled unless there are no patients available for injury. People’s behavior and knowledge will always be imperfect, and therefore iatrogenic patient injuries will continue to occur. However, every patient injury could have been prevented.
By espousing the belief that all injuries can be prevented, it is clear that leaders do not accept the notion that patient injuries are out of the organization’s control. Medical accidents don’t just happen; they are caused by people working in faulty systems. By frankly recognizing this fact, management is establishing the basis for effective patient safety improvement efforts.
2. Management is responsible for the prevention of patient injuries. This statement places the burden for patient safety on leaders at all levels in the organization. Management cannot "wash its hands" of patient safety responsibilities by urging staff to be safe. Be careful not to transfer patient safety responsibilities to the safety officer or patient safety committee, thereby letting managers off the hook. The safety officer or committee should be a resource to help the organization achieve a risk-free environment for patients, but the ultimate responsibility must still lie with the leadership.
3. All patient hazards can be safeguarded. This principle is a commitment to the idea that patient care activities can be organized to function in a fail-safe manner. While hazards are known to exist in health care services, patients can be safeguarded against these hazards. The principle makes possible the concept that physicians and staff should not take risks while caring for patients. Hazards are safeguarded (rendered free of risk) by physical safeguards or through operating procedures that, when followed, will avoid patient injury.
4. Training is essential. The basic principle involved here is that people new to a job — whether a new employee, a reassigned employee, or an employee confronting new or revised equipment or procedures — cannot be expected to work safely without being trained. This training should include information about the hazards of the new tasks and about the rules and procedures necessary to avoid patient injuries. There is also the need for training in the patient safety policy.
5. Patient safety is good business. The concept that "patient safety saves money" is an important part of an organization’s patient safety policy. The idea that patient safety is a good thing only if "we can afford it" will not engender organizationwide support. The wording for this policy statement must be very carefully considered; otherwise, people might think that patient safety improvement is be pursued for its economic value alone.
6. Patient safety is a condition of employment. This key element of a patient safety policy simply makes known the fact that management will not continue to put patients at risk if an employee has repeatedly demonstrated an inability to protect patients from harm. The organization has the legal obligation to remove such employees from patient care situations. It should seldom be necessary to exercise this provision. It must, however, be part of the tools available to managers if a safe patient care environment is to be created.
What should be emphasized in the patient safety policy is management’s commitment to establishing an environment in which health care services can be provided without injury to patients. The patient safety policy is a set of principles upon which this commitment becomes operational. To be effective, these principles must not be platitudes. They must be clear statements that individuals in the organization can actually use in determining their actions. An example of a hospital patient safety policy accompanies this article. (See hospital patient safety policy, p. 109.)
After the patient safety policy is developed, it must be communicated to people in the organization. Communication of the policy should not be accomplished simply by its publication (e.g., posted on bulletin boards or an article in the hospital safety bulletin). There must be a thorough explanation of why a new policy has been prepared and how people are affected by it. This is best accomplished by having each member of the top management team explain the policy statement to his or her immediate subordinates in separate meetings called for this purpose. If questions arise at the middle management level, they should be adequately addressed before further down-the-line communication takes place. Middle managers and supervisors should conduct instructional meeting with subordinates. Medical staff leaders should share the policy at various committee meetings.
The objective is a thorough understanding of the patient safety policy by all employees and physicians who practice in the facility. Once this objective is accomplished, the policy can be incorporated into departmental policy manuals and be available as a reference to guide future decisions and to use in connection with new employee and physician orientation.
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