Despite substantial effort over the past 20 years, preventable harm in health care remains a major concern in the United States. Though many evidence-based, effective best practices related to harm reduction have been identified, they are seldom shared nationally and implemented effectively across multiple organizations.
Reducing preventable harm requires a concerted, persistent, coordinated effort by all stakeholders, and a total systems approach to safety.
Health Care That Is Safe, Reliable, and Free from Harm
Safer Together: A National Action Plan to Advance Patient Safety provides clear direction that health care leaders, delivery organizations, and associations can use to make significant advances toward safer care and reduced harm across the continuum of care.
The report harnesses the knowledge and insights of the
National Steering Committee for Patient Safety (NSC) members, including influential federal agencies, leading health care organizations, patient and family advisors, and respected industry experts, into a set of actionable and effective recommendations to advance patient safety.
The National Action Plan centers on four foundational and interdependent areas, prioritized as essential to create total systems safety. The recommendations in these four areas build on the substantial body of experience, evidence, and lessons learned that the NSC has gathered and will test and implement together to allow for future refinements as our understanding, experience, and evidence evolve over time.
National Action Plan: 17 Recommendations to Advance Patient Safety
Culture, Leadership, and Governance
1. Ensure safety is a demonstrated core value.
2. Assess capabilities and commit resources to advance safety.
3. Widely share information about safety to promote transparency.
4. Implement competency-based governance and leadership.
Patient and Family Engagement
5. Establish competencies for all health care professionals for the engagement of patients, families, and care partners.
6. Engage patients, families, and care partners in the co-production of care.
7. Include patients, families, and care partners in leadership, governance, and safety and improvement efforts.
8. Ensure equitable engagement for all patients, families, and care partners.
9. Promote a culture of trust and respect for patients, families, and care partners.
10. Implement a systems approach to workforce safety.
11. Assume accountability for physical and psychological safety and a healthy work environment that fosters the joy of the health care workforce.
12. Develop, resource, and execute on priority programs that equitably foster workforce safety.
13. Facilitate both intra- and inter-organizational learning.
14. Accelerate the development of the best possible safety learning networks.
15. Initiate and develop systems to facilitate interprofessional education and training on safety.
16. Develop shared goals for safety across the continuum of care.
17. Expedite industry-wide coordination, collaboration, and cooperation on safety.
The Self-Assessment Tool, a supplemental resource to the National Action Plan, assists leaders and organizations in deciding where to start.
Implementation Resource Guide
The Implementation Resource Guide, a supplemental resource to the National Action Plan, details specific tactics and supporting resources for implementing the National Action Plan recommendations.