Technology has a prominent role to play in a patient-safety campaign, but using it too early in the effort could be costly and unproductive.
More important at the outset is a keen awareness of how provider organizations can become breeding grounds for medical errors, a problem that can be countered only by committing to a comprehensive safety-first strategy and getting everyone to understand it.
That advice from a healthcare consulting firm is part of an accelerated education initiative commissioned by the Child Health Corporation of America to get its 38 member hospitals on a fast track to patient-safety improvement.
The Shawnee Mission, Kan.-based hospital alliance established the safety program within its ongoing Child Health Accountability Initiative, which targets improvements in health outcomes for children through research, collaborative efforts and knowledge-sharing.
Spurred by greater public scrutiny of their medical quality, healthcare providers are starting to organize into regional or like-minded coalitions to stimulate creation of a broad safety strategy.
One of the first such efforts was in Massachusetts, which by March 1999 had amassed a consensus of best practices to prevent medication errors. Other regional efforts include a patient-safety forum in Wisconsin that developed 10 recommendations for improving medication safety along with suggested milestones to reach by January.
The coalition of children's hospitals wanted to know how members were addressing patient-safety issues and how to proceed systematically to build a sustainable strategy for improvement, says David Classen, M.D., vice president of the performance-improvement practice at First Consulting Group, Long Beach, Calif.
Officials of the CHCA declined to be interviewed or disclose findings of the consultant's assessment, but Classen says the effort led to a plan for logical progression toward a sharp patient-safety focus.
A first piece of advice is to resist calls to buy expensive information systems to enhance clinical operations before facing up to more fundamental shortcomings in the way care is delivered, he says.
"There's a tendency to try to solve the problem with technology first, because it's easier to bring in technology instead of tackling the tougher problems of reorganization," Classen says. It's part of a scatter-shot approach that often results when executive management leaves it to departments to seize the initiative instead of directing an overall response to clearly defined operational challenges, he says.
An initiative to institute bar-coding in medication administration, for instance, might spring up as a priority before the organization understands the nature of the overall risk and the need to change attendant-care processes as a first step, he says.
Without coordination at the top, safety improvements also can be thought out and implemented in one nursing unit but not distributed throughout the hospital, says Dona Stablein, a process redesign specialist in the patient-safety practice of First Consulting. Other units over time might think of the same things, but "the organization shouldn't have to learn safety initiatives over and over again across the same organization," she says.
The subject of patient safety is just beginning to be raised at the strategic level, Stablein says. "It takes a strong executive leader or strong board member to push this through the organization."