Patient Safety

Improving patient safety in hospital and health systems remains a global public health concern and an essential component of health care quality. It necessitates a comprehensive approach that involves shared principles and values in the promotion and implementation of a positive safety culture, an effective risk management program, and high-quality teamwork to reduce medical errors and prevent their occurrences.

Safety culture

A strong safety culture is fostered by effective leadership and a set of shared values and beliefs about patient safety at the organisational and individual level, from staff to top management.  A combination of commitment and action that influences others to do the same can drive best practices and improve patient safety.

A safety culture assessment that relies both on qualitative and quantitative approaches is known as “mixed methods”. Currently, the most widely used method in the healthcare sector is quantitative and makes use of surveys addressed to professionals. Culture safety surveys that are designed to assess how teams and institutions perceive healthcare safety can thus be leveraged to target educational needs and positively impact progress.

To foster and strengthen safety culture, the HAS developed 3 guides (only available in French)  in collaboration with the Federation of Regional and Territorial Organisations for the Improvement of Health Practices (FORAP), to implement and measure a safety culture, and set up actions for continuous improvement.

The HAS also developed a guide on safety walk-around (only in French): a one-hour discussion on patient safety between a management team and medical unit. The aim of this approach is to identify problems encountered directly on the field that may benefit from a shared action plan.

Risk management

To err is part of all human activity. Healthcare, a complex adaptive system, is no exception to this rule. The various combinations of healthcare delivery, coupled with human factors, render the system error prone thus increasing the risk and occurrence of care-related adverse events. Therefore, effective risk management strategies, geared to reduce the number of adverse events to acceptable levels, are central in mitigating system failures that contribute to patient safety.

To help hospitals and health systems (e.g., home hospitalisation) improve their risk management program, the HAS developed several tools such as:

• a surgical safety checklist made mandatory in 2010. Several versions adapted to specific situations were developed in digestive endoscopy, bronchial endoscopy, interventional radiology, central venous catheter, chemotherapy, and hospital discharge after 24 hours or more;
• guides (only in French) on how to implement risk management in hospitals, and more specifically to implement health simulation, report a care-related injury, and reconcile drug treatments ;
• guides (only in French) on task interruptions during anaesthetic activities and drug administration to identify at-risk processes, offer support for carrying out a diagnostic audit, and recommend prevention and recovery barriers;
• a guide, videos, and surveys (only in French) in connection with the High5s international project, to encourage the use of surgical markings in reducing site or procedural errors.

The HAS works in conjunction with health professionals, users of the healthcare system and patients to develop healthcare quality and safety indicators (QSI). Moreover, the HAS is developing patient safety indicators (PSI4) to measure the recovery of 5 post-surgical complications (only in French).

Care-related adverse events analysis

Required as a part of a risk management program, detecting, reporting, and analysing adverse events help to inform learning opportunities. Thus, the HAS is developing tools to improve the analysis of adverse events in hospital, ambulatory and social care settings (videos, guides, monitoring sheets, etc.).

The HAS also promotes :

• the analysis of adverse events in Morbidity and Mortality Ground Rounds (only in French);
• the use of the ALARM grid (only in French) to improve root cause analysis of adverse events that are more closely linked to system failures (organisation, coordination and communication) rather than a lack of clinical knowledge;
• the analysis of barriers that have worked, or not, to develop realistic solutions that improve safety.

It also provides a framework for two adverse events reporting systems:

• voluntary reporting as part of the accreditation of doctors and medical teams;
• mandatory declaration of serious adverse events in health care institutions, in ambulatory care and in the medico-social sector since 2016.

These two adverse events reporting and feedback systems allow the HAS to develop:

• "Patient Safety Solutions". These solutions are a practical tool for health professionals, with key points highlighted, such as a What not to do / What to do messages. They contain guidelines to facilitate implementation for daily practice.
  • Fixation bias in healthcare. How to see the light at the end of the tunnel? ;
  • "No Go" in the operating theatre. How to reinforce safety barriers ;
  • Managing risks associated with electrosurgical devices ;
  • Securing the circuit of a sample collected in the operating theatre ;
  • How can we reduce the risks associated with the creation of a pneumoperitoneum in digestive surgery? ;
  • Cooperation between anaesthetists-resuscitation specialists and surgeons. Working better as a team ;
  • What actions to take when finding moisture in boxes of sterile instruments after patient incision ;
  • How to avoid confusion between antiseptic and injectable anaesthetics ;
  • How to reduce wrong-site skin lesion excision.
• “Focus on patient safety": it is a series of documents describing several situations (healthcare-related adverse events), identified and selected as being of educational interest and for their quality of analysis in the adverse events feedback system database.
• Analysis of adverse events on specific topics (Covid and safety barriers, risk management and IT tools…).

Teamwork

Analysis of adverse events showed that dysfunctional teamwork is a root cause for their occurrence.

In 2012, the HAS published a guide to support the development of a cooperation protocol between health professionals (only in French). In 2016, the analysis of 776 adverse events led to the development of the Patient Safety Solution “Cooperation between anaesthetists-resuscitation specialists and surgeons- Working better as a team » outlining 15 key points to improve teamwork.

Moreover, the HAS developed tools (teaching sheets, training videos) dedicated to facilitating communication between professionals, such as SAED (Situation – Medical History – Evaluation – Demand, only in French) or the Briefing-Debriefing method (only in French).

In addition, the HAS offers 2 voluntary programmes to improve teamwork:

• the accreditation process of doctors and medical teams;
• a programme for the continuous improvement of teamwork in hospitals (the PACTE project). Over the two-year programme period, teams are supported by a referent pair (health manager - doctor) and by a facilitator from outside the hospital.

Despite the overwhelming stress and fatigue resulting from the Covid pandemic, health care team performance remains critical particularly in crisis situations. The HAS therefore developed tools to meet the specific challenges of the Covid crisis (only in French) : improving the welcoming and integration of new members, communication and management of teams in times of crisis.

Patient communication

Patient safety also depends on patient involvement. To improve communication between patients and health professionals, the HAS made several tools available:

• the “Teach-back” (only in French) tool;
• guides for shared decision-making (only in French) and to help user representatives become involved in the accreditation of healthcare organisations (only in French);
• brochures « Dare to talk to your doctor » (only in French) and « Talking to your pharmacist » (only in French).