Learn from what goes right: A demonstration of a new systematic method for identification of leading indicators in healthcare

Abstract The work in patient safety is often centred on adverse events and errors. Typical methods to improve patient safety are reactive and focus on understanding past failures. This article presents the development of a proactive method towards improving patient safety and understanding why processes function as intended on a daily basis. The paper presents the steps of how the method was developed and demonstrates it by using a former case study of early detection of sepsis. Emphasis is on understanding complex processes and identify aspects important for things going right and achieving intended outcomes. The study resulted in the development of six overall steps for identifying leading indicators in complex healthcare processes. These were (1) identification of relevant functions, (2) cluster of functions in sets, (3) identification of functions with variability, (4) identification of functions with upstream–downstream functions, (5) identification of leading indicators, and (6) confirmation of leading indicators through experts and adverse events. The study outlined the development a new method on the topic of leading indicators in the context of patient safety.

[1]  L Debarberis,et al.  Effectiveness evaluation methodology for safety processes to enhance organisational culture in hazardous installations. , 2008, Journal of hazardous materials.

[2]  E. Hollnagel.  FRAM: The Functional Resonance Analysis Method: Modelling Complex Socio-technical Systems , 2012 .

[3]  Erik Hollnagel,et al.  Safety-I and Safety-II: The Past and Future of Safety Management , 2014 .

[4]  Shi-Kuo Chang,et al.  An Interactive System for Chinese Character Generation and Retrieval , 1973, IEEE Trans. Syst. Man Cybern..

[5]  Mark-Alexander Sujan,et al.  Computer Safety, Reliability, and Security , 2014, Lecture Notes in Computer Science.

[6]  Jens Rasmussen,et al.  Skills, rules, and knowledge; signals, signs, and symbols, and other distinctions in human performance models , 1983, IEEE Transactions on Systems, Man, and Cybernetics.

[7]  J. Braithwaite,et al.  Learning from incidents in health care: critique from a Safety-II perspective , 2017 .

[8]  Jason R. W. Merrick,et al.  Leading Indicators of Safety in Virtual Organizations , 2007 .

[9]  Mark-Alexander Sujan,et al.  An organisation without a memory: A qualitative study of hospital staff perceptions on reporting and organisational learning for patient safety , 2015, Reliab. Eng. Syst. Saf..

[10]  Michael P. Broadribb,et al.  Cheddar or Swiss? How strong are your barriers? , 2009 .

[11]  Jason R. W. Merrick,et al.  Accident precursors and safety nets: leading indicators of tanker operations safety , 2007 .

[12]  Barbara B. Kawulich.  Participant Observation as a Data Collection Method , 2005 .

[13]  Erik Hollnagel,et al.  Is safety a subject for science , 2014 .

[14]  Charles Vincent,et al.  Safety measurement and monitoring in healthcare: a framework to guide clinical teams and healthcare organisations in maintaining safety , 2014, BMJ quality & safety.

[15]  Erik Hollnagel.  SAFETY MANAGEMENT – LOOKING BACK OR LOOKING FORWARD , 2016 .

[16]  Sophia Antipolis,et al.  Proposing safety performance indicators for helicopter offshore on the Norwegian Continental Shelf , 2010 .

[17]  M. Sujan.  What keeps patients safe? A Resilience Engineering perspective , 2016 .

[18]  Stig Ole Johnsen,et al.  Proactive Indicators To Control Risks in Operations of Oil and Gas Fields , 2012 .

[19]  Jeffrey Braithwaite,et al.  Resilient health care: turning patient safety on its head. , 2015, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[20]  Ingrid Bouwer Utne,et al.  Building Safety indicators: Part 1 – Theoretical foundation , 2011 .

[21]  R. Wears,et al.  Patient Safety: A Brief but Spirited History , 2016 .

[22]  K. Malterud.  Qualitative research: standards, challenges, and guidelines , 2001, The Lancet.

[23]  Ingrid Bouwer Utne,et al.  Building Safety indicators: Part 2 - Application, practices and results , 2011 .

[24]  C. Vincent.  Integrating Safety and Quality , 2010 .

[25]  Stavroula Leka,et al.  Developing a performance indicator for psychosocial risk in the oil and gas industry , 2014 .

[26]  J. Mainz.  Defining and classifying clinical indicators for quality improvement. , 2003, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[27]  G. D. Edkins.  The INDICATE safety program: evaluation of a method to proactively improve airline safety performance , 1998 .

[28]  P. Hudson,et al.  Applying the lessons of high risk industries to health care , 2003, Quality & safety in health care.

[29]  Jan Mainz,et al.  Selection of indicators for continuous monitoring of patient safety: recommendations of the project 'safety improvement for patients in Europe'. , 2009, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[30]  M. Dixon-Woods,et al.  The problem with root cause analysis , 2016, BMJ Quality & Safety.