Patient safety will not improve just by setting new rules
For the purpose of improving patient safety, VTT Technical Research Centre of
Finland has developed a new management model based on customer needs. All the
actors taking part in the organizational activity in social and health care
organizations play a key role in safety management – including the patient.
Both in Finland and abroad, there is a clear need for the systematic
improvement of patient safety. Patient safety cannot be improved by simply
making new rules. On the contrary, sometimes new rules could make the work of
healthcare professionals more complicated and even reduce safety. A new kind
of adaptive safety management is required. This new, customer-needs-based
management model is already being used at Vaasa Central Hospital.
Patient safety is not just a matter of concern for individual professionals.
Rather, it is a product of the entire organisation’s actions. The new adaptive
management model takes account of the networked nature of health care,
unbroken treatment chains for patients and the well-being of healthcare
”Patient-safe management must be viewed as a common cause. In addition to
harmonising rules and procedures, cooperation between actors and
self-organisation must be supported. Patients should also be viewed as part of
management and better use should be made of their personal expertise”, says
VTT Senior Scientist Elina Pietikäinen.
”Discussion mainly revolves around highly visible issues related to patient
safety, such as falls. However, patient safety can also be endangered in an
unnoticed, gradual manner. For example, poor nutrition can present a safety
problem in long-term care.”
A key goal is to create good preconditions that help experts identify the
hazards related to their work, how their work connects to that of others, and
to do their jobs flexibly and well. This requires long-term, consistent safety
management and steering of organisational culture.
Patients themselves also play an important role in ensuring patient safety.
For example, patients can report dangerous situations via the same system as
that used by nurses. Patients should be given more information about the
hazards and risks related to taking their medication, for example, and receive
guidance in the safe use of medicine. It is not enough that patients know what
to do. They should also understand why things are done in the way they are,
and what might happen if the patient, for one reason or another, is unable to
comply with treatment instructions.
Representatives of patients' associations can participate in the design of
hospital practices and changes in them, contributing the perspective of the
group they represent. In many cases, patients' associations have first-hand
knowledge of typical risks and problems related to treatments, as well as
ideas on new solutions for them. They can function as go-betweens between
patients and hospitals.
Patient safety a competitive advantage
Vaasa Central Hospital is a pioneer in systematic patient safety development.
At this hospital, patients and their next-of-kin have already been given
greater involvement in patient safety management. Initiated by a few key
persons, this has gradually spread to become an organisational force for
At first, systematic patient safety management emphasised the harmonisation
and guidance of the actions of individuals and units, but more focus has
gradually been given to the other key principles of adaptive patient safety
management. For example, groups and networks for facilitating communication on
matters related to patient safety have been established in Vaasa. Regular
evaluations of the state of patient safety have also begun, and long-term
development goals related to patient safety have been set for the organisation.
The organisation has also encouraged discussion of how personnel might
flexibly account for patient safety in the conflicts they encounter in their
daily work. Vaasa Central Hospital has appointed special patient safety
experts and working groups, which also include representatives of patients'
associations. Patients can also use the hospital's incident system to report
any incidents they may encounter. The core objective is to make the patient
safety perspective part of daily work, normal management and interaction with
New products and services required
The safety of services will be a significant competitive advantage for social
and healthcare organisations in the future, from the perspective of both
employees and patients. Development needs related to patient safety also
entail business opportunities, since there is a lack of safety management
expertise in the field.
The recently completed two-year 'SafetyAsset - Patient safety as an asset in
social and health care' project resulted in the development of new tools and
services in support of patient safety management. For example, the project saw
the birth of the Patient Safety Report online service developed by Huperman
Oy, the SPro patient safety planning tool by Awanic Oy, and NHG Audit's
down-to-earth operating model for training and development of quality and
patient safety in healthcare organisations.
VTT has been one of the central forces in encouraging discussion on patient
safety in Finland. Achievements include the HaiPro incident reporting system
developed at VTT and the related procedure (currently maintained by the
spin-off company Awanic), which have been widely adopted by Finnish healthcare
organisations. The system has been a crucial tool in advancing the development
of patient safety in Finland.
During the 'SafetyAsset - Patient safety as an asset in social and health
care' project, VTT has further developed the TUKU safety culture, for
evaluating the state of safety within organisations. The questionnaire is used
by several operative social and healthcare units. It is hoped that the
questionnaire will help to create a better overall understanding of the
challenges and strengths facing patient safety management in the Finnish
social and healthcare system.
The 'SafetyAsset - Patient safety as an asset in social and health care'
project was implemented through cooperation between VTT, the Finnish Institute
of Occupational Health, the Hospital District of Vaasa and companies that
offer healthcare services and products, such as Awanic Oy, Huperman Oy and NHG
Audit Oy. The project was funded by Tekes and the participants.
The Adaptive Patient Safety Management Report online: /Documents/2012_T58.pdf