Patient Safety and Quality

Studies examine how to improve patient safety with instructional systems design

The Institute of Medicine (IOM) has recommended the redesign of health care systems in the 21st century to make them safer and more effective, patient-centered, timely, efficient, and equitable. How does one achieve care quality and safety by design? Also, is it possible to actually design in quality and design out failure? These are a few of the questions addressed in a special 2006 issue of Quality and Safety in Health Care, 15 (1 Suppl.).

Following are brief summaries of articles that appear in the issue, which were written either by researchers at the Agency for Healthcare Research and Quality (AHRQ) or by AHRQ-supported researchers.

Battles, J.B. "Quality and safety by design," pp. 1-3.

This author introduces the topic of the journal supplement by providing a three-level conceptual framework for the six quality aims laid out by the Institute of Medicine. The first, or core, level of the framework would be designing for patient-centered care, with safety as the second level. The third level of design would address efficiency, effectiveness, timeliness, and equity. Design methods and approaches are available that can be used for the design of health care organizations and facilities, notes the author. These methods and approaches can also be used for design of learning systems to train and maintain competency of health professionals, clinical systems, clinical work, and information technology systems.

Reprints (AHRQ Publication No. 07-R043) are available from the AHRQ Publications Clearinghouse.

Battles, J.B. "Improving patient safety by instructional systems design," pp. 25-29.

One way to ensure safety by design is to apply established design principles to education and training, notes the author. Instructional systems design (ISD) is a systematic method of developing education and training programs for improved learner performance. The ISD process involves five integrated steps: analysis, development, design, implementation, and evaluation (ADDIE). The application of ISD using the ADDIE approach can eliminate as a factor or prevent education and training from being a contributing factor to health-related injury or harm, and can also be effective in preventing injury or harm.

Reprints (AHRQ Publication No. 07-R044) are available from the AHRQ Publications Clearinghouse.

Henriksen, K. and Dayton, E. "Issues in the design of training for quality and safety," pp. 17-24.

Despite swift advances in medical science and technology, cost containment and productivity pressures on clinicians make the clinical environment less than ideal for training. The theoretical underpinnings and design aspects of training have been largely unrecognized and unexamined in health care, note the authors of this paper. They describe how health care training and education can benefit from findings in the behavioral and cognitive sciences. Next, they explore the extent to which a systems approach to training can be applied to the clinical environment. Finally, they examine innovative training and education techniques that are already gaining acceptance in health care.

Reprints (AHRQ Publication No. 07-R042) are available from the AHRQ Publications Clearinghouse.

Carayon, P., Hundt, A.S., Karsh, B-T., and others. "Work system design for patient safety: The SEIPS model," pp. 50-58. (AHRQ grant HS11561).

Most errors and inefficiencies in patient care arise from conflicting, incomplete, or suboptimal systems. Thus, models and methods of work system design need to be developed and implemented to advance research in and design for patient safety, note the authors of this paper. They describe how the Systems Engineering Initiative of Patient Safety (SEIPS) model of work system and patient safety can be used toward these ends. The SEIPS model provides a framework for understanding the structures, processes, and outcomes of health care and their relationships. The authors apply the SEIPS model to the outpatient surgery setting and describe other practice and research applications of the model.

Karsh, B-T., Holden, R.J., Alper, S.J., and Or, C.K. "A human factors engineering paradigm for patient safety: Designing to support the performance of the healthcare professional," pp. 59-65. (AHRQ grant HS13610).

The main paradigms for directing patient safety improvement efforts to date have focused on reducing injuries, reducing errors, or improving evidence-based practice. The authors of this paper propose a human factors engineering paradigm that focuses on designing systems to improve the performance of health care professionals and to reduce hazards. They provide several arguments to show that designing health care delivery systems to support health care professional performance and hazard reduction should yield significant patient safety benefits.

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