Editorial

Citation

Downey-Ennis, K. (2006), "Editorial", International Journal of Health Care Quality Assurance, Vol. 19 No. 7. https://doi.org/10.1108/ijhcqa.2006.06219gaa.001

Editorial

Demands for efficiency, cost effectiveness and seamless patient service is now commonplace. However, it has been the drive for patient safety that has dominated the quality arena in recent times with hospitals being pushed to adopt techniques and strategies used in non-health sectors to assure this basic right – safety. While many sets of ideas, philosophies, principles and methods have emerged, it may take a significant time for the discipline of quality management to mature within healthcare for many reasons, which I will discuss later. Indeed, (Magud, 2006) suggests that the twenty-first century may well become know to historians as the century of quality in healthcare.

It can be argued that healthcare has lagged behind other fields in this regard such as the aviation industry in deploying a systematic approach to the identification and prevention of errors. Like aviation healthcare organisations must strive to become a high reliability one, which can be best, described as an organisation that operates effectively and efficiently in complex and challenging environments while simultaneously achieving low levels of failure.

Safety became firmly rooted in the quality agenda following the publication of The Institute of Medicine (IOM) seminal report “To Err is Human: Building a Safer Health System” which revealed that errors caused between 44,000 and 98,000 deaths every year in American hospitals, and over one million injuries. The report fundamentally triggered international conversations to focus on changing systems and motivated hospitals to engage in and adopt safer practices internationally. Leape et al. (1995) suggests that system design errors normally refer to an error that occurs because of a deficiency in the design of the system.

In high hazard industries it is well recognised and accepted that it is bad systems and not errant people that are the main cause of the majority of errors and injuries and which in these industries is the scientific foundation for improvement of safety. This concept has now become a widespread belief in healthcare. Leape et al. (1995) proposed that improvement of the magnitude envisioned by the IOM requires a national commitment to strict, ambitious, quantitative, and well-tracked national goals. However, (Stelfox et al., 2006) indicate that while there is an increasing number of patient safety publications and research awards which may indicate that the IOM report had a major impact on patient safety research there still remains a window of opportunity for health care to follow other high risk industries in establishing basic safety. So how far have we come since the publication of the IOM report?

Several publications have emerged such as ‘Building a Safer NHS for Patients in 2001, which resulted in the development of the National Patient Safety Agency whose main remit is to improve patient safety through the setting up of a reporting and learning system for patient safety incidents and near misses. Other countries have followed in this respect with the Clinical Indemnity Scheme in Ireland and The National Patient Safety Foundation in the USA, both of which have added impetus to the debate on patient safety. The Institute for Healthcare Improvement (IHI) in the US has helped hospitals redesign their systems for safety through demonstration projects, system changes, and training in implementation of safe practices for thousands of physicians, nurses, and pharmacists. The 100,000 lives campaign an initiative to engage US hospitals in a commitment to implement changes in care proven to improve care and prevent avoidable deaths has revealed unprecedented results over its eighteen months duration in that through the involvement of 3,000 hospitals they have collectively prevented an estimated 122,300 avoidable deaths and more importantly have begun to institutionalise new standards of care that will continue to save lives and improve health outcomes into the future (www.ihi.org).

Despite these facilitating factors and innovations dissemination is sometimes slow if at all in healthcare. This maybe due to a combination of complexity, professional fragmentation entrenched by a hierarchical authority structure and diffuse accountability all of which form a compelling barrier to creating the habits and beliefs of common purpose, teamwork and individual accountability for successful interdependence that a safe culture requires. A paper in this issue describes a methodology for disseminating good practice to the wider healthcare audience.

While all of the above will be of benefit the challenge for hospital leaders is to embrace methods used in high reliability organisations internationally to improve processes and systems and to ensure that processes are managed end to end so as to avoid failure. Business methodologies such as Six Sigma, lean thinking and total quality management (TQM) all offer a potent cure for the ailment of health in respect of patient safety.

Kay Downey-EnnisCo-Editor