Understanding the Basics of Patient Safety

This chapter introduces the fundamental concepts of patient safety. Research underlying the basic concepts of patient safety comes from outside health care, primarily from engineering, aviation, psychology, and sociology. These areas of inquiry replace the impoverished conceptualization of error reduction with the more robust concept of complex adaptive systems. The framing principles are  

Medical accidents are symptoms of a disease of the health care system. 

Medical accident must be studied, without judgments, as if it were a physiological state. 

Identified system vulnerabilities are useful as initial data sources to prevent failure from reaching a patient. 

Health care s fear-based culture has thwarted exploration of weaknesses in the system s work processes, causing the industry to lose rich information about how individuals, technical work, and organizational processes interact. When accidents and near misses are thought of as the symptoms of an underlying problem, they become sources of information and valuable tools to understand how a system functions. Accidents and near misses are useful tools that help define the margins of risk and safety and help us to learn about how harm can be prevented (Amalberti, 2001). 

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Chapter Two, Error and Harm in Health Care, departs momentarily from the patient safety manifesto, as already mentioned, to provide background knowledge on current research in patient safety, the patient safety movement to date, and the reasons why today s health care system is so error-prone. Chapter Three, Understanding the Basics of Patient Safety, provides an overview of basic concepts and terms in the science of patient safety. These concepts and terms fe>rm the foundational touchpoints of the book. 

In conclusion, this chapter demonstrates that the IRT approach can provide additional insights to psychometric properties of the HSOPSC. Both, the classical and modem approaches, are needed to form a complete picture of the properties of a set of items. Understanding the basic principles of IRT will hopefully foster its use more widely within the field of patient safety culture assessment. This will ultimately enhance our ability to measure this important constmct accurately. 

The study of patient safety is the study of complexity. The study of complexity invites us to understand key concepts that can be applied to patient safety. Basic concepts from the fleld of patient safety are sharp and blunt end active and latent failure the Swiss Cheese Model of Accident Causation slips, lapses, and mistakes and hindsight bias and the fundamental attribution error. Key concepts from organizational analysis, such as normalization of deviance, diffusion of responsibility, tightly coupled work processes, and sensemaking, introduce practical lessons from high-reliability organizations. Application of specific lessons to health care are explored in Chapter Five. 

The ability to communicate ensures that basic needs are met, preserves autonomy, and is a means of survival and safety. The inability of MV patients to communicate has the potential to result in anxiety, loss of control, and social isolation. If natural speech cannot be restored, then it is necessary to use methods that supplement or replace natural speech. For this purpose, an understanding of the anatomy of speech and language is essential. Ventilator-supported speech requires careful patient selection for those who can tolerate cuff deflation... 

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