A lot of patient safety work focuses primarily on specific “projects” — like reducing CLABSI or preventing pressure ulcers. While this work is obviously essential, it’s important to step back, take the long view, and build the internal structure to avoid undertaking work in a vacuum.
You might read that paragraph and think, “Sure, that sounds good. But who has time for that?”
It’s a reasonable question. There are so many demands coming at health care providers. It can be challenging to think beyond the task that’s right in front of you or the ones for which you’re being held accountable. It often feels like you don’t have time to do more.
But imagine if you launch a falls prevention initiative. It takes time, but you start to see some steady improvement. If you don’t place the work you’re doing into the broader context of the other efforts your organization is undertaking, you may end up having trouble keeping the momentum going, making further improvement, or sustaining your gains. Or you may find yourself competing for staff time or other resources with teams focused on equally worthy efforts, instead of working cooperatively and integrating or sequencing your projects so they build on and learn from each other.
If you don’t want to waste your time and the good will of those you’re working with, consider using the Framework for Safe, Reliable, and Effective Care.
The value of the Framework
The Framework is made up of two foundational domains — culture and the learning system — along with nine interrelated components, with patients and families at the core.
People often come to IHI’s Patient Safety Executive (PSE) Development Program, which we’ve been teaching for well over a decade, with a particular area they need to work on — medication safety, for example. The PSEaculty tell the participants that they can use a specific initiative as their entrée to working on patient safety, but it’s just the beginning.
If you want to ensure medication safety — or the long-term success of any safety initiative — you need all the components of the Framework. You need leadership commitment, teamwork, good communication, and reliable systems. You need psychological safety, accountability, the ability to negotiate, transparency, and continuous learning. You need an improvement strategy as well as a measurement strategy.
The Framework can be your guide to ensure you’re applying the strategic, clinical, and operational concepts that are critical to achieving safe, reliable, and effective care. Organizations like MemorialCare Health System use it as their patient safety roadmap. You can also use it as a diagnostic tool to determine how well (or if) your organization is working on all of the different components of the Framework.
If you’re taking on any kind of improvement work — particularly around safety — the Framework can help. Its principles apply to a variety of settings and scales. While initially focused on acute care, the Framework has evolved to be more broadly applicable to include ambulatory care, home care, long-term care, and other care in the community.
The path to high reliability
Many health care organizations are now trying to become high-reliability organizations (defined as “organizations which have fewer than normal accidents”). This makes sense because highly reliable organizations in industries like nuclear power and aviation are on average much safer than those in health care. Even when an error or incident occurs, they deal with it much more quickly and effectively than other organizations.
What many people miss, however, is that you need a solid infrastructure in order to embody the principles of high reliability. It takes standardization of processes to reduce variation. It takes psychological safety, so anyone within the organization will speak up when they see something wrong. The elements in the Framework can form the foundation of an organization’s high-reliability journey.
The Framework can help a health system organize its efforts to build systems of safe, reliable care, and ensure it builds the necessary key components to achieve ongoing success. But it is essential for organizations to allocate the necessary time and resources to build its safety infrastructure. If you don’t make time, you may end up frustrated, duplicating efforts, working at cross purposes with others, or wasting precious time and resources.
Redesigning a system of care is complicated and should not be rushed. But we owe it to our patients to begin the journey on solid footing, and this means improving your processes, changing your culture, and developing a learning system. The Safety Framework can be a great place to start.
Frank Federico is a Vice President at IHI. He is faculty for IHI’s Patient Safety Executive (PSE) Development Program.
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