… Int J Qual Health Care … Leadership engagement is key to … five key strategies for practical action are described. … Amalberti R, Staines A, Vincent C. Embracing multiple aims in …

In the second of a two-part series, using examples from newborn units, the authors present a framework for supporting practitioners in low-resource settings to improve patient safety across four areas: (1) prioritizing critical processes, (2) improving the organization of care, (3) control of risks, and (4) enhancing responses to hazardous situations.

… Int J Qual Health Care … The authors of this editorial propose a … the learning system to develop resilience . … Staines A, Amalberti R, Berwick DM, et al. COVID-19: patient safety and quality …

Health care is considered a high-risk industry due to clinical, administrative, economic, and regulatory stressors. This review explores a range of approaches to managing the safety of patients in this complex environment. The authors suggest that acceptance of the inability to eliminate all risk, focus on known problems, and engagement of all managerial levels is required to improve reliability.

In-depth review and analysis of adverse events can both inform and detract from progress in patient safety. This commentary suggests that the early event analysis approaches have not achieved their potential. The authors describe changes needed to improve incident analysis methods, including engaging patients and families in assessments and investigating a longer time period to understand the full patient care experience.

This prospective study elicited incident reports from general practitioners for all types of adverse events occurring in primary care. Most events were judged to be preventable, and incidents were frequently due to the organization of care rather than from knowledge gaps on the part of physicians. These results underscore the need to focus on organizational factors in primary care to improve patient safety.

The systems approach to analyzing adverse events emphasizes how active errors (those made by individuals) and latent errors (underlying system flaws) contribute to preventable harm. Adverse events in ambulatory care may arise from an especially complex array of latent errors. This paper explores the role of time management problems, which the authors term "tempos," as a contributor to errors in ambulatory care. Through a review of closed malpractice claims, the authors identify 5 tempos that can affect the risk of an adverse event: disease tempo (the expected disease course), patient tempo (timing of complaints and adherence to recommendations), office tempo (including the availability of clinicians and test results), system tempo (such as access to specialists or emergency services), and access to knowledge. The role of these tempos in precipitating diagnostic errors and communication errors is discussed through analysis of the patterns of errors in malpractice claims. A preventable adverse event caused by misunderstanding of disease tempo is discussed in this AHRQ WebM&M commentary.

This study tracked adoption of a process-oriented safety rule and found that compliance eroded over time, with a major trigger being lack of compliance by a senior staff member. The authors provide caution about the role of policies to promote safety behaviors, particularly if such policies are not prioritized by staff as important.

This article outlines how classifying complexity levels of adverse events may inform more effective information technology approaches to safety improvement.

The authors submit that a broader approach to patient safety would better improve the quality of care.

This commentary builds on the notion that our health care system requires structured efforts to improve safety and reliability. The authors summarize five primary barriers: accepting limitations on maximum performance, abandoning professional autonomy, transitioning from the "mindset of craftsman to that of an equivalent actor," needing system-level arbitration to optimize safety strategies, and simplifying professional rules and regulations. Each of these barriers is discussed with thoughtful perspective on both the associated historical and current contextual factors. In comparing safety strategies with other industries, a specific health care framework is also offered, raising distinctions that pose unique challenges. The article concludes with graphic presentation of a strategic view of safety in health care and the construct for a two-tiered system in which one system achieves "ultrasafe" status while the other does not at a calculated and accepted risk.