Mater's Best Shot
Mater set out some years ago to be ‘the safest hospitals in Australia’. This is not easy as there is no definition of ‘safety’, and no universally agreed measures; and no consistent means of comparing one hospital’s overall outcomes with another. We don’t have a ‘My School’ ranking system for hospitals—yet. We do measure many of the components of patient safety, and we do benchmark our outcomes against internationally published standards determined through research. This gives us some confidence that IF ‘safety’ could be reduced to one measure, we would perform well, probably very well, and maybe even at national or international best practice.
Good as all that is, is it enough? In my view, no. For two reasons—first, we need to find a way to prove objectively the assumption above that we ARE a safe hospital, and second, being ‘the best’ if we could prove it, would not be sufficient if we were still causing or contributing to avoidable injury, disability and death in the process of ‘care’.
If we adopt this line of thought it leads to two conclusions; for each of the components of patient safety we must start working on the objective measurement of outcomes. Without this data we can have no knowledge if changes to our systems and processes are making a positive or negative difference. By this process of continuous improvements, measurement, management and a deep organisation-wide commitment to patient safety then we might prove we are ‘safest’.
Then the hard part starts—how do we get from ‘safest’ to ‘no preventable harm’? There is an abundance of good quality literature to suggest this is not achievable by gradual improvement. Just as the airlines didn’t get to outstanding levels of reliability and safety by incremental change, hospitals probably won’t get to ‘zero preventable harm’ without a huge shift in organisational culture.
What does a ‘safety culture’ look like in hospital? How does it feel? My task is not to reproduce the extensive literature on this subject—it is there to read if you like. Try “Why Hospitals Should Fly” by John Nance as a starter or look at 'if air travel worked like health care'. The Youtube clip shows just how far we have to go—and this example just relates to getting in the front door, not being safely anaesthetised and operated upon, and recovering without ‘adverse events’!
We also know that safe hospitals have the following features:
- High volumes of patients having similar procedures
- Standardised care paths
- Standardised systems and routines for everything—from prepping a patient to taking out the rubbish
- High ratios of experienced staff and low staff turnover
- Staff who trust each other, and who also check everything, once, at the right time
- A high level of involvement of the patient in their care—where possible the care being managed by the patient
- Regimented handover between staff at shift changes, focussing on risks to good patient outcomes
- Systems of care designed so that the risk of error is ‘designed out’—don’t stock concentrated potassium infusions on general wards, as a recent and local example.
- High levels of team work—hospitals in which admissions are done with the nurse, doctor and pharmacist in the patient’s room concurrently have high patient satisfaction, well planned care which is well known to the patient, and no medication errors—that’s not a typo—NO medication errors, and very few ‘system errors relating to the usual problem in hospitals—poor communication between staff.
Oh, and did I mention that an integral part of any safe hospital is zero harm of staff?
There’s more but this is a diatribe off the cuff not a text book!
We can say ‘zero preventable harm’ for patients is all too hard; there may be a thousand reasons ‘why not’ which we can debate and discuss for another 200 years like we have with hand washing, or we can give it our best shot.
Best shot it is then.