Is quality safety or safety quality? Peter Lachman Inspiring and driving improvement in the quality and safety of healthcare worldwide through education and knowledge sharing, external evaluation, supporting health systems and connecting people through global networks.

Can one have quality care without being safe?

Can one have safe care and not have quality?

Quality Effective care Efficient care Safe care Good access to care Equitable care Person centred Safe care

Is quality all about person centred care?

Safety is about what really matters for people Personalised Safe care Coordinated, Safe and Effective care Enabling Safe care Dignity and compassion http://www.health.org.uk/public/cms/75/76/313/4772/Measuring%20what%20really%20matters.pdf?realName=GuxZKx.pdf

Safety is all about culture Generative Safety is how we do business here Increasing informedness or mindfulness Proactive We work on problems we still find Calculative we have systems in place to manage all hazards Reactive Safety is important - we do a lot when something happens Increasing information Pathological It is ok as long as nothing happens Hudson P. Applying the lessons of high risk industries to health care Qual Saf Health Care 2003

Improvement aims to move healthcare Safety is how we do business here

Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives, the cumulative experience of many masters of craftsmanship. Quality also marks the search for an ideal after necessity has been satisfied and mere usefulness achieved. Will Foster

An improvement approach for safety Quality and safety planning Quality and safety control Standards Quality and safety management Quality and safety improvement Based on Juran

Sensitivity to operations A framework for the measurement and monitoring of safety Safety What did we do well? Past Harm Reliability Sensitivity to operations Anticipation Learning Source: Vincent C, Burnett S, Carthey J. The measurement and monitoring of safety. The Health Foundation, 2013. www.health.org.uk/publications/the-measurement-and-monitoring-of-safety

Quality and safety are about systems Understand the system in which we work Variation in the system Examine the way people think – beliefs and attitudes Do they believe safety is our business? Theory and method of change Based on Deming

Charles Vincent Rene Amalberti Safer Healthcare Strategies for the Real World https://link.springer.com/content/pdf/10.1007%2F978-3-319-25559-0.pdf

Charles Vincent Rene Amalberti Safer Healthcare Strategies for the Real World https://link.springer.com/content/pdf/10.1007%2F978-3-319-25559-0.pdf

Aim to do what we are supposed to do reliability Regarding small errors as a symptom that something is wrong Preoccupation with failure Paying attention to what’s happening on the front-line Sensitivity to operations Encouraging diversity in experience, perspective, and opinion Reluctance to simplify Capabilities to detect, contain, and bounce-back from events Commitment to resilience Pushing decision making down to the front line Deference to expertise Aim to do what we are supposed to do reliability Contain Anticipate Based on Weick and Sutcliffe 15

Safe and reliable quality care Effective Right treatment Access Right place Where, how and when Timely No delays in diagnosis or treatment Person centred & equitable Personalised care Efficient Right care giver ward or clinic

Learning to be resilient in face of complexity Learning from what works as well as what does not work And Being safe under all conditions Reference Hollnagel and Braithwaite

And to this one needs to understand context and study generalisability

Key elements for quality and safety Listen to patients Share decisions Enable Listen

Safety Person Quality

Email: plachman@isqua.org peterlachman