Achieving Ultrasafe Health Care: 5 barriers

Here is a sort synopsis of an interesting and mind provoking article by Amalberti, Berwick, Auray and Barach. It brings back the discussion about how do we compare with ultra safe industries, and how many steps do we have to take to bring us to that much needed point of safety.

Becoming ultrasafe may require health care to abandon traditions and autonomy that some professionals erroneously believe are necessary to make their work effective, profitable, and pleasant.
Reliable measurement of health care and patient safety outcomes is the first challenge for health care benchmarking

The 5 barriers to achieve ultra safe health care are:


1. Acceptance of Limitations on Maximum Performance
 - When limits do not exist—that is, the prevailing attitude is “attain a specified high level of production, no matter what it takes”—the system in question is very unsafe.
- Of note, the professionals who act under these conditions are often highly competent. Low safety levels do not arise from in- competence. The greater risks in complex domains are in- curred by experts who challenge the boundaries of their own maximum performance. The more audacious the ex- pert, the more risky the adopted strategies and the more frequent the adverse outcomes.

2. Abandonment of Professional Autonomy
 - the barrier of too much autonomy cannot be overcome completely when teamwork must extend across departments or geo- graphic areas, such as among hospital wards or departments (silo mentality)

3. Transition from the Mindset of Craftsman to That of an Equivalent Actor
- health care professionals must face a very difficult transi- tion: abandoning their status and self-image as craftsmen and instead adopting a position that values equivalence among their ranks.
- Conversely, most patients specifically request and can recall the name of their surgeon. Often, the patient has chosen the surgeon and believes that the result of surgery could vary according to that choice. This view is typical of a craftsman market.

4. Need for System-Level Arbitration To Optimize Safety Strategies

 - Top management views safety in terms of mitigating the conse- quences of a crisis, so as to avoid jeopardizing the total organization. To them, patient safety is just another source of risk, among other sources that have similar con- sequences to the organization, such as troubled industrial relations or inadequate cash flow.

5. The Need To Simplify Professional Rules and Regulations

 - The fifth barrier typically derives from the perverse effect of excellence. It is generated by the accumulation of layers that are intended to improve safety but make the system overly complex, burdensome, and ultraprotected.

To paraphrase Reason, speaking of the aviation community in the 1980s, the current efforts to improve patient safety are akin to “fighting mosquitoes, but not draining the swamp [of error]”