Proactive, Transdisciplinary Safer-System Redesign. A Field Report from the Hospital Frontline

Background: Today, most healthcare systems can be described as “compliant organizations”. However, as the patient safety movement continues to prosper, many scholars have proposed to evolve from a reactive approach toward a more proactive one that better addresses risks for preventable harm.
Purpose: Proactive organizations aim to achieve resilience. Stanford Health Care is trailblazing by integrating safety science experts into clinical practice who work in tandem with clinicians to proactively design work systems for safer, more effective, patient-centered care.
Methods: Adapting the human-centered design approach, a transdisciplinary team of engineers, physicians, and nurses utilizes an array of methods and tools to identify and analyze systems-related issues proactively and comprehensively, to search for and test a variety of solutions, to select the best options, implement solutions successfully, and to monitor sustainability of improvement.
Results: The team-conducted projects, e.g., to improve blood administration and to standardize set-up and management of cerebrospinal fluid drainage systems. Our accomplishments so far, include the systematic examination and comprehensive description of clinical work systems, their components and interactions, successful collaboration with clinical and support services throughout the organization, and the redesign of IT systems, medical devices, and nursing procedures. The efforts also led to price reductions by 50% for a single medical device. Since the completion of the projects, we have had no related adverse patient event, no associated litigation, and the nursing and service-quality indicators are within the satisfactory target range.
Conclusions: The SHC Advancing Patient Safety Program is a novel endeavor that analyzes systems issues in an organization-wide manner, executes improvement work in a comprehensive and integrated fashion, is a conduit for innovation, and is a medium for breaking through boundaries and silos thus fostering deeper collaboration among disciplines.