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Improved Patient Safety

Developing a Patient-safety Culture


Mark Callahan, M.D., New York Presbyterian Healthcare Network.

Eric Thomas, M.D., M.P.H., University of Texas Medical School at Houston.

Patricia Sokol, R.N., J.D., Program Manager, National Patient Safety Foundation.

While data collection, reporting and analysis, and establishing new processes and procedures for reducing medical error and improving patient safety are important, little progress can be achieved without developing a culture within and across health care institutions, providers, and patients that embraces and emphasizes the importance of patient safety. Three presenters shared insights about the issues, tools and strategies for making this happen:

  • Dr. Mark Callahan emphasized that physicians and hospital administration leadership is key to the development of a patient safety-focused organization. He identified a number of promising approaches to engage physicians and other senior decisionmakers, including:
    • Consider financial incentives and rewards to influence behavior.
    • Reexamine and reform the licensing and tort laws, which inhibit open communication.
    • Work with early adopters and clinical champions.
    • Fund open demonstration projects designed to decrease medical errors and improve patient safety.
    • Establish a State-wide error reporting system that is used to promote quality improvement rather than one that is focused on punitive sanctions.
  • Dr. Eric Thomas and his colleagues at the University of Texas developed the Safety Attitudes Questionnaire and the Safety Climate Survey to measure health perspectives and experiences on key patient safety issues in their facilities. The Safety Attitudes Questionnaire has been administered to over 100 institutions and includes responses from 100,000 providers on job satisfaction, perception of management, working conditions, etc. The Safety Climate Survey measures provider and staff perceptions of a strong and proactive organizational commitment to patient safety. To date, over 10,000 providers have completed the survey. Its findings can be used for benchmarking, to prompt interventions, and to measure changes over time in an institution's safety climate.
  • Engaging patients and families is another key component to developing a culture of safety. Patricia Sokol of the National Patient Safety Foundation (NPSF) highlighted the devastating impact that medical errors can have on patients and their families. In response, the NPSF's Patient and Family Advisory Task Council established an agenda that provides a roadmap for action which States and health care organizations can use to develop a patient-centered culture of safety (

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