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Patients to be more involved in decision-making


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 personnel.

”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 change.

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 patients.

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