Seminar C3 – Methodologies underlying patient safety

 

Errare humanum est – perseverare diabolicum… We all know that errors cannot be totally avoided in the complex area of medicine. However, our role is to implement and apply methodologies aiming at managing the risk in our processes, in both proactive and reactive ways. Inspired by high risk industries such as aviation, several methodologies for this have been developed.

 

Errors can occur, but any organization should “take advantage” of them, to avoid the repetition of similar incidents. To reach this objective, errors must be reported in a blame-free culture and the possible root-causes analysed using a structured methodology. At the end, corrective measures can be determined to continuously improve the quality and the safety of the processes.

 

To prevent is always better than to heal… Prospective risk analysis methods have been developed to help managers of high risk activities to determine critical points in their organization and to secure them even before an incident arises. These techniques are very helpful to get a deep understanding of the role of each contributor in a process, to take improvement actions when they appear to be reasonable and to accept objectively the residual risks.

 

Reactive and proactive methods are complementary approaches that should be developed in every hospital to underlie patient safety strategies.

 

 

• To present examples of incident reporting systems and associated approaches to learning from incidents;

• To present an example of the application of a prospective risk analysis on the medication process;

• To discuss the barriers to the implementation of these methodologies in the hospital setting.

 

 

After the workshop the participant should be able:

 

• to apply both reactive and proactive methodologies in their patient safety strategies;

• to compare these approaches and how they can be used together;

• to appraise the importance of a blame-free culture.