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Establishing a Patient Safety Culture, Part Two

Key elements of a successful patient safety officer program

Published: Thursday, July 5, 2012 - 12:21

Editor's note: Part one of this three-part series on patient safety, "Establishing a Patient Safety Culture," offered an overview of the Juran Model for Patient Safety. Part Two takes a closer look at Juran's patient safety curriculum and certification.

It has been 22 years since the Institute of Medicine published a report on medical errors and avoidable harm, and yet many hospitals are still desperately struggling to tackle these issues. Continued patient safety events attest to a general lack of defined leadership and infrastructure to support the necessary cultural and process improvements.

Many organizations rely solely on implementing best practices or incremental safety improvements rather than training and empowering frontline staff on patient safety principles, improvement methods, and tools. At the Juran Institute, our experiences have shown that breakthrough improvement in safety happens project by project, by identifying and solving chronic problems using evidence-based methodologies and tools. A successful patient safety officer (PSO) understands improvement methodologies and tools and has the ability to lead and engage the frontline staff in improving safety.

The health care environment requires a systems-oriented, interprofessional attitude and a patient-centered approach for optimal patient safety. Health care workers require new skills and knowledge to meet the changing needs of patients in a complex health care environment. Certification as a PSO ensures that leaders are prepared to meet the constantly evolving requirements of the persistently challenging health care environment.

Patient safety events occur when a high-risk condition and a high-risk action happen together. An analogy can be made with driving. If an individual is driving in high-risk conditions—for example in stormy weather at night—and exhibiting a high-risk action such as driving under the influence of alcohol, then the chances of an accident occurring are much greater. The same equation exists in health care and just about every other high-risk industry.

The PSO must understand not only the system issues and chronic problems that create high-risk conditions, but also the factors that lead to human error, otherwise known as high-risk actions. The PSO must develop the skills of both leaders and staff to recognize high-risk conditions and understand how their actions contribute to the possibility of a patient safety event. Establishing behavioral expectations and providing the tools by which employees can satisfy these behaviors is vitally important.

Juran’s patient safety curriculum
In response to this need, Juran Institute has designed a patient safety curriculum to help patient safety professionals understand and apply their key contributions to improve patient care and outcomes. The Juran Patient Safety Curriculum consists of five-phases. (See figure 1.)

Figure 1: The Juran Patient Safety Curriculum
Click for larger image.

The purpose of PSO certification is to empower professionals by offering real work and practical certification opportunities. The program addresses the core competencies vital to patient safety progress and innovation across the continuum of care:
• Fundamentals of patient safety
• Patient safety assessment
• Human performance
• Patient safety management system
• Breakthroughs in patient safety

At the conclusion of the program, Juran issues individual certifications to qualified candidates. (See figure 2.)

Figure 2: Requirements for PSO certification
Click for larger image

With hospital and health care agencies increasingly designing and implementing new patient safety practices, employees will benefit from the professional credentials earned in the PSO program. Employees will benefit from the focus on interprofessional teamwork communication and collaboration, reducing medical errors, and living the values necessary for creating a culture of safety. By attending to the issues of patient safety and creating plans to effectively reduce risk and potential for error, officers will gain the knowledge and skill to design and implement a comprehensive approach to error science management.

Responsibilities of a PSO
The primary responsibilities of the PSO are to become an expert in the methods and tools required for proactive process improvement, and to understand the myriad factors that contribute to human errors. Even in a state of true process control, all organizations experience both chronic and sporadic problems. Chronic problems are defined as being observable and due to common cause variation in a system. Sporadic problems are defined as infrequent defects due to a special cause variation.

To solve chronic problems, the PSO facilitates multidisciplinary teams using methodologies such as lean and Six Sigma, which address variation and waste in the system. Using project teams allows the PSO to identify the root causes of chronic problems to achieve breakthrough improvement. To solve sporadic problems, the PSO uses a team-based approach and applies tools such as root cause analysis (RCA) and special cause analysis (SCA). RCA is used for more complex events, where both process and human factors exist. SCA is used for less complex events, where either process or human factors exist. RCA involves the use of a multidisciplinary team, whereas SCA can be performed by a single individual.

Variation and waste are caused by many factors, including poor process design and the skills and behaviors of humans. By focusing on process and culture over time, the PSO can effectively improve outcomes by increasing the overall reliability of the system. (See figure 3.)

Figure 3: Increase of reliability over time

The PSO is also responsible for designing and establishing the optimal infrastructure to support proactive patient safety and accountability. This infrastructure includes a steering committee comprised of both operational and clinical leaders. The steering committee provides oversight of the patient safety program, including patient safety strategies, goal deployment, policies, governance, measurement, and improvement initiatives. Developing the infrastructure also includes considering the type of training required for all levels of the organization. Even though the PSO is the leader and expert, knowledge of the methods and tools must exist throughout the organization at all levels.

In summary, the PSO plays a role in shaping how we respond to patients when we fail. The PSO effectively engages administrative leaders, clinical leaders, and frontline caregivers in the process of transformation. The PSO is both a facilitator of change and redesign, and at the same time acts as an enforcer to ensure that the safety practices are adopted at all levels of the organization. A PSO is knowledgeable and has the influence and power to make change happen.

Juran Healthcare offers strategies and solutions that have been proven to gain statistically significant improvements in patient safety.


About The Authors

Mary Beth Edmond’s picture

Mary Beth Edmond

Mary Beth Edmond is an executive vice president and senior nurse executive with Juran Healthcare, as well as a lean Six Sigma Black Belt. She assists clients in designing and implementing enterprisewide quality assurance systems, quality improvement deployment strategies and plans, business process management, enterprisewide patient safety programs, lean Six Sigma coaching and project support, and organizational performance assessments.  Edmond has 40 years of healthcare experience in nursing and consulting for community hospitals, academic medical centers, and ambulatory surgical centers.


Jonathan Flanders’s picture

Jonathan Flanders

Jonathan Flanders is a vice president and patient safety executive with Juran Institute specializing in the implementation of business transformation management, patient safety, and Lean and Six Sigma. His specific areas of knowledge and expertise include emergency departments, laboratory, revenue cycle, medication management, surgical services, outpatient clinics, inpatient throughput and flow, and core measure performance.