Abstract
Improving patient safety has become a core issue for many modern healthcare systems. However, knowledge of the best ways for government initiated efforts to improve patient safety is still evolving, although there is considerable commonality in the challenges faced by countries. Actions to improve patient safety must operate at multiple levels of the healthcare system simultaneously. Using the example of the NHS in England, this article highlights the importance of a strategic analysis of the policy process and the prevailing policy context in the design of the national patient safety strategy. The paper identifies a range of policy "levers" (forces for change) that can be used to support the implementation of the national safety initiative and, in particular, discusses the strengths and limitations of the "business case" approach that has attracted recent interest. The paper offers insights into the implementation of national patient safety goals that should provide learning for other countries.
Full Text
The Full Text of this article is available as a PDF (64.4 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Arah O. A., Klazinga N. S. How safe is the safety paradigm? Qual Saf Health Care. 2004 Jun;13(3):226–232. doi: 10.1136/qshc.2003.007070. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Baker G. Ross, Norton Peter G., Flintoft Virginia, Blais Régis, Brown Adalsteinn, Cox Jafna, Etchells Ed, Ghali William A., Hébert Philip, Majumdar Sumit R. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ. 2004 May 25;170(11):1678–1686. doi: 10.1503/cmaj.1040498. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Berwick Donald M. A user's manual for the IOM's 'Quality Chasm' report. Health Aff (Millwood) 2002 May-Jun;21(3):80–90. doi: 10.1377/hlthaff.21.3.80. [DOI] [PubMed] [Google Scholar]
- Brennan T. A., Leape L. L., Laird N. M., Hebert L., Localio A. R., Lawthers A. G., Newhouse J. P., Weiler P. C., Hiatt H. H. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991 Feb 7;324(6):370–376. doi: 10.1056/NEJM199102073240604. [DOI] [PubMed] [Google Scholar]
- Collins C., Green A., Hunter D. Health sector reform and the interpretation of policy context. Health Policy. 1999 Apr;47(1):69–83. doi: 10.1016/s0168-8510(99)00003-2. [DOI] [PubMed] [Google Scholar]
- Devers Kelly J., Pham Hoangmai H., Liu Gigi. What is driving hospitals' patient-safety efforts? Health Aff (Millwood) 2004 Mar-Apr;23(2):103–115. doi: 10.1377/hlthaff.23.2.103. [DOI] [PubMed] [Google Scholar]
- Donaldson Liam. Patient safety: global momentum builds. Qual Saf Health Care. 2004 Apr;13(2):86–86. doi: 10.1136/qshc.2004.010587. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Leape L. L., Berwick D. M. Safe health care: are we up to it? BMJ. 2000 Mar 18;320(7237):725–726. doi: 10.1136/bmj.320.7237.725. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Leatherman Sheila, Berwick Donald, Iles Debra, Lewin Lawrence S., Davidoff Frank, Nolan Thomas, Bisognano Maureen. The business case for quality: case studies and an analysis. Health Aff (Millwood) 2003 Mar-Apr;22(2):17–30. doi: 10.1377/hlthaff.22.2.17. [DOI] [PubMed] [Google Scholar]
- Small Stephen D., Barach Paul. Patient safety and health policy: a history and review. Hematol Oncol Clin North Am. 2002 Dec;16(6):1463–1482. doi: 10.1016/s0889-8588(02)00066-7. [DOI] [PubMed] [Google Scholar]
- Stevens Simon. Reform strategies for the English NHS. Health Aff (Millwood) 2004 May-Jun;23(3):37–44. doi: 10.1377/hlthaff.23.3.37. [DOI] [PubMed] [Google Scholar]
- Vincent C., Neale G., Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ. 2001 Mar 3;322(7285):517–519. doi: 10.1136/bmj.322.7285.517. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wilson R. M., Runciman W. B., Gibberd R. W., Harrison B. T., Newby L., Hamilton J. D. The Quality in Australian Health Care Study. Med J Aust. 1995 Nov 6;163(9):458–471. doi: 10.5694/j.1326-5377.1995.tb124691.x. [DOI] [PubMed] [Google Scholar]
- de Roo A. A., Maarse H. A. Understanding the central-local relationship in health care: a new approach. Int J Health Plann Manage. 1990 Jan-Mar;5(1):15–25. doi: 10.1002/hpm.4740050104. [DOI] [PubMed] [Google Scholar]