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Safer Healthcare


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Table of Contents

Foreword SECTION I : FOUNDATIONS1. Progress and challenges for patient safetyProgress on patient safetyHarm has been defined too narrowlySafety is a moving targetOnly part of the healthcare system has been addressedWe are approaching in the same way in all settingsOur model of intervention is limitedHealth care is changing2. The ideal and the realThe day-to-day realities of healthcareThe ideal and the real: five levels of careThe cumulative impact of poor quality careExplicit discussion of the real standard of care is criticalWhat is the impact of improving quality standardsLevels of care and strategies for safety improvement3. Approaches to safety. One size does not fit allApproaches to risk and hazard: embrace, manage and avoidThree approaches to safetyRules and adaptationApplying the three models to healthcareMoving between modelsReflections on the safety ideal4. Seeing safety through the patient's eyesWhat do we mean by harm?Safety and quality of care from the patient's perspectiveSafety through the patient's eyesRethinking patient safety SECTION II : STRATEGIES FOR THE REAL WORLD5. Consequences for incident analysisWhat are we trying to learn when we analyse incidents?Essential concepts of ALARMESelect problems for analysis which are important to patientsWiden the time frame of analysis: adopt the concept of event journeyConsider success, detection and recovery as well as failureAdapting the analysis to context6. Strategies for safetyWhat options do we have for improving safetyIntroducing safety strategies: optimisation, risk management and innovationStrategy 1: Safety as best practiceStrategy 2: Improvement of work processes and systemsStrategy 3: Risk controlStrategy 4: Monitoring, adaptation and response Strategy 5: Mitigation: responding to harmInnovationSelection and customisation of strategies to clinical context7. Safety strategies in hospitalsA little historySafety hospitals: distinguishing current and future strategiesSafety as best practiceImproving the system Risk controlMonitoring, adaptation and recoveryMitigationRegulatory and political determinants of approaches to safetySafety in context: the many hospital environments8. Safety strategies for care in the home An ageing population and the expansion of home careThe challenges of delivering healthcare in the homeThe hazards of home care: new risks, new challengesInfluences on safety of healthcare delivered in the homeSafety strategies and interventions in the home careOptimization strategies in home care: best practice and system improvementRisk control strategies in home careMonitoring, adaptation and response strategies in home careMitigationReflections on home care strategyThe role of regulation in home care9. Safety Strategies in Primary careRisk control strategiesMonitoring, adaptation and responseMitigation, responding to harmStrategies for the real worldOur central arguments and proposalsDevelopment and validationImplications for patientsImplications for managers and executives SECTION III CHALLENGES AND ACTIONS10. New challenges for Patient safetyNew challenges for patient safetyThe risk of transtionA global revolution rathen than a local evolution11. Bringing all togetherFirst transitionSecond transitionThird transitionFourth transition12. Strategies for the real worldOur central arguments and proposalsDevelopment and validationImplications for patientsImplications for managers and executivesImplications for regulators

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This is an open access book, the electronic versions are freely accessible online.

About the Author

Rene Amalberti is 61 years old, Prof. Medicine, MD, PhD. After a residency in Psychiatry, he integrated the Airforce in 1977, got a permanent Military Research position in 1982, and became Professor of Medicine in 1995. He retired in 2007 and is now Senior advisor Patient Safety at the HAS (Haute Autorite de Sante) and Chief scientific officer of the French association La Prevention Medicale. He has published over 100 international papers, and authored or co-authored 10 books on human error and system safety (last Navigating safety, Springer, 2013).
Charles Vincent trained as a Clinical Psychologist and since 1985 has carried out research on the causes of harm to patients, the consequences for patients and staff and methods of improving the safety of healthcare. He was Professor of Psychology at University College London before moving to the Department of Surgery and Cancer at Imperial College in 2002 where he directed the Imperial Centre for Patient Safety & Service Quality. He is the editor of Clinical Risk Management (BMJ Publications, 2nd edition, 2001), author of Patient Safety (2ned edition 2010) and author of many papers on medical error, risk and patient safety. He is currently a Health Foundation Fellow and Professor of Psychology at the University of Oxford.

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