Safety of care

Improving patient safety and reducing risks

Change is good: Taking action on healthcare safety

Originally published May 2015
P1502-4-E

In the quest toward making healthcare safer, physicians and other healthcare providers must first uncover those practices which pose an avoidable and unacceptable risk to patients. Once unsafe practices are exposed, the next step is to take action. But where do you begin?

Researching best practices

Based on various factors such as personal observation of potential risks or reading about best practices, physicians may conclude that a practice needs to be made safer. After determining an activity needs to change, physicians typically look for evidence-based research, choose a new approach from the most appropriate activity, and adapt it to their setting.

In the search for evidence-based practices, doctors and other providers can refer to numerous resources such as those offered by the Canadian Patient Safety Institute and the Agency for Healthcare Research and Quality in the United States. They can also turn to medical and healthcare organizations for evidence-based research. The Canadian Medical Association, for instance, offers CMA Infobase, a database of Canadian clinical practice guidelines. The College of Family Physicians of Canada website offers links to databases and search tools that contain guidelines, systematic reviews, primary research, and critically appraised topics. Through its extensive educational resources, the Canadian Medical Protective Association identifies potential risks in medical care based on research into medico-legal cases.

Doctors may also want to explore the online resources offered by universities with healthcare faculties. For example, the University of British Columbia’s Continuing Professional Development program offers an online resource called “This Changed My Practice.”1 There, a team of local opinion leaders distill the findings from clinical trials and identify those which were significant enough to change how they deliver care.

Some governments also offer best practice resources. The Government of Manitoba, for instance, offers online patient safety resources focused on healthy living and seniors.2 Many libraries provide a wealth of information as well. For example, the Cochrane Library provides access to the Cochrane Reviews — internationally recognized reviews of primary research in healthcare and health policy.

Physicians may also want to research ready-to-adopt patient safety strategies. In 2013 the Agency for Healthcare Research and Quality published the article “Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices.”3 The article evaluated the evidence for a large number of patient safety practices, for example, using preoperative checklists and identifying patients at risk for suicide. It identified practices that are “strongly encouraged for immediate adoption by healthcare providers” as well as ones that are “encouraged” for adoption.

After evaluating the evidence healthcare providers should also think about how the recommended practices will fit into their particular setting. For example, will the new activity be appropriate for the patient population’s characteristics and values? Does the new activity require skills, equipment, or other resources, and are these available? Will physicians be able to measure the outcomes the changes have brought to their practice?

Choosing an approach

The next step is finding an approach, model, or framework to begin moving evidence-based information into practice. More than ever, physicians and other healthcare providers have a plethora of implementation models to choose from.

The Canadian Patient Safety Institute (CPSI), for example, provides a detailed framework called Improvements Framework, Getting Started Kit, available on the institute’s website.4 Geared to interprofessional and interdisciplinary teams, the kit is based on the PDSA cycle (Plan, Do, Study, Act). The CPSI also offers information on other frameworks, such as Six-Sigma, Positive Deviance (PD), and Lean Improvement.

The Canadian Institutes of Health Research also offers a framework guide for healthcare practitioners. Titled Moving into action: We know what practices we want to change, now what? An implementation guide for health care practitioners,5 the online tool provides steps for implementing changes based on evidence.

In determining which framework to use, healthcare providers should consider which one best suits their particular situation. For instance, a simplified model is likely better suited to a solo medical practice, while more complex models may be more appropriate for larger organizations.

Barriers and facilitators

Implementing new safety practices is more effective when healthcare providers take potential barriers and facilitators into consideration. Barriers and facilitators can be identified by examining the characteristics of the proposed change, individual care providers, local setting, and organization (i.e. resources and culture).

Research shows that innovations will be more easily adopted if healthcare providers view them as being evidence-based and more beneficial than the old practices. Innovations requiring new knowledge or skills are more likely to be adopted if the providers see them offering an opportunity to grow professionally. Conversely, this innovation may be a barrier if the resources for gaining new skills are not readily available.6 Changes in practice are more successful when healthcare providers know a new approach is urgently needed because the status quo is inadequate,7 and when providers are engaged in the change process and have an opportunity to contribute their knowledge and expertise.

The use of champions — individuals appointed to promote and mentor the adoption of an innovation — may be beneficial in helping to implement change, particularly when clinical champions work with managerial and executive champions.8

A patient’s attributes can also either impede or facilitate practice innovation. Patients with strong literacy skills, for instance, may be better equipped to take an active role in their care and make a change easier to introduce.9 Low levels of individual health literacy have been found to contribute to poorer health outcomes, increased risk of adverse events, and higher healthcare costs.10 Giving patients or their family specific information on what they can do to manage their healthcare may increase their health literacy.

Measuring the impact, sustaining the change

Finally, when implementing a change, physicians and other providers must determine how they will know if the change improved care. In their implementation plans, they should include a data collection methodology to ascertain whether the change had a positive effect on safety or not.

Many organizations offer tools on how to test changes. For example, the Canadian Patient Safety Institute’s Getting Started Kit!11 provides instructions on testing changes. If the change is positive, the kit gives providers information on how to sustain it.

Changing practice, improving safety

Transferring evidence-based research into practice requires effort and a well thought-out plan. Physicians and other providers can improve the safety of healthcare by identifying evidence-based research and practices, choosing an effective plan or framework for making the change, considering potential barriers and facilitators, testing the impact of the change, and considering the change’s sustainability.

 
 

References

  1. Faculty of Medicine, University of British Columbia, “This Changed my Practice.” Accessed January 21, 2015 from: http://thischangedmypractice.com/
  2. Government of Manitoba, “Manitoba Health, Healthy living and seniors.” Accessed January 21, 2015 from: http://www.gov.mb.ca/health/patientsafety/resources.html
  3. Agency for Healthcare Research and Quality (US), “Making health care safer II: An updated critical analysis of the evidence for patient safety practices,” March 2013. Comparative Effectiveness Review No. 211AHRQ Publication No. 13-E001-EF. Accessed January 21, 2015 from: http://www.ahrq.gov/research/findings/evidence-based-reports/ptsafetyuptp.html
  4. Canadian Patient Safety Institute, “Improvement frameworks getting started kit,” October 2011. Accessed January 21, 2015 from: http://www.patientsafetyinstitute.ca/English/toolsResources/ImprovementFramework/Pages/default.aspx
  5. Canadian Institutes of Health Research, “Moving into action: We know what practices we want to change, now what? An implementation guide for health care practitioners,” March 28, 2012. Accessed January 21, 2015 from: http://www.cihr-irsc.gc.ca/e/documents/lm_moving_into_action-en.pdf
  6. Ibid, p.12
  7. Kotter, John P., Leading Change, Harvard Business Review Press, 1996, ISBN 9781422186435
  8. Soo, S., Whitney, B, Baker, R. “Role of champions in the implementation of patient safety practice change,” Healthcare Quarterly (2009) Vol. 12, p.128
  9. Canadian Institutes of Health Research, “Moving into action: We know what practices we want to change, now what? An implementation guide for health care practitioners,” March 28, 2012, p.16. Accessed January 21, 2015 from: http://www.cihr-irsc.gc.ca/e/documents/lm_moving_into_action-en.pdf
  10. Australian Commission on Safety and Quality in Health Care, “Health literacy,” Accessed January 26, 2015 from: http://www.safetyandquality.gov.au/our-work/patient-and-consumer-centred-care/health-literacy/Patient safety expertise
  11. Canadian Patient Safety Institute, “Improvement frameworks getting started kit,” October 2011. Accessed January 21, 2015 from: http://www.patientsafetyinstitute.ca/English/toolsResources/ImprovementFramework/Pages/default.aspx

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.