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Report

What’s done to improve patient safety? Initiatives in seven countries

Published Updated

This report provides a brief overview of some selected, but at the same time key elements of how other countries are dealing with patient safety. The countries included in this study are Australia, Canada, Denmark, England, Scotland, Sweden and the United States.

This report provides a brief overview of some selected, but at the same time key elements of how other countries are dealing with patient safety. The countries included in this study are Australia, Canada, Denmark, England, Scotland, Sweden and the United States.


Key message

The Norwegian Knowledge Centre for the Health Services is running a national patient safety campaign “In Safe Hands” from 2010-2013. The campaign will be continued as a national program for patient safety from January 2014.

As part of the preparation of the program the Knowledge Centre examined how other countries have set patient safety on the agenda by searching websites from Australia, Canada, Denmark, England, Scotland, Sweden and USA. Patient safety is prominent on the health policy agenda in all the countries. 

The health system varies across the countries. Denmark, England, Scotland and Sweden all have a public universal health­care, where the public also is the main provider of services. Canada and Australia have publicly-funded health insurance, with a mixture of a public and private provision of services (including hospitals). In the United States the health service is for a large part funded through private insurance. Providers are also private institutions. The public (universal) offers are, and have largely been limited to a few larger programs (MEDICARE and MEDICAID).

There have been running patient safety campaigns in Australia, Canada, Denmark, England and the United States. Scotland and Sweden have programs that are reminiscent of campaigns. All countries have reporting systems for adverse events and Sweden seems to have the oldest one. The Canadian national reporting system is limited to medication incidents. Building competence and capacity in patient safety is a recurrent theme. Australia, Canada, England and Scotland are integrating patient safety and quality, Webinars are provided by academic institutions to build competence and capacity, and in Australia, Canada and the United States there are certification of patient safety education.

Little information is available regarding funding of patient safety in hospitals. There is an an ongoing debate regarding use of economic incentives in the services. The zero-vision of patient harm is pronounced in Australia, England and Sweden, but is implemented as a national effort within limited areas. Both Canada and The United States started early with systematic evaluation of patient safety efforts, and it seems to be increasing in scope. Denmark’s latest initiative will be evaluated. The American evaluation identified the knowledge gap regarding implementation of patient safety.

Summary

In 2007 the National unit for patient safety were established and located in the Norwegian knowledge centre for the health services. The purpose of the unit was to support the health service's effort to record, analyse, learn from and prevent errors and adverse events. A national patient safety campaign "In Safe Hands" was launched by the Ministry of Health and Care Services in January 2011 and is hosted by the knowledge centre. The campaign will be continued as a national program for patient safety in 2014. In preparation of the program the knowledge centre examined information available on the web about how some countries present their work with patient safety at the national level.

This report provides a brief overview of some selected, but at the same time key elements of how other countries are dealing with patient safety.

Methods

The countries included in this study are Australia, Canada, Denmark, England, Scotland, Sweden and the United States. These countries have been selected because they all, in different ways have carried out major efforts to improve patient safety. We've included background information on the organization of health care and patient safety in the various countries, and about the different efforts such as campaigns and adverse event reporting systems. It is also sought after national objectives and evaluations related to patient safety, as well as information about the building of competence in patient safety and how patient safety efforts are funded. The evaluation of the single tools and resources are not included. Information about the countries are retrieved from Internet sites to the countries' health ministries and the patient safety organizations that are included. The method used is snow ball sampling combined with mining of websites to obtain additional information about individual initiatives.

Each country is described by a brief presentation of:• How the health care are organised

  • The goal for patient safety
  • The central institutions in the field of quality and patient safety• Activities in patient safety (priorities/opt-in arrangements)
  • Competence in patient safety
  • Funding
  • Results from evaluations in which they exist.

Results

Patient safety is high on the health policy agenda in all of the countries covered by the report. This is true regardless of how the health care is organised and funded. Denmark, Sweden, England and Scotland have, in essence, a publicly organised and funded health service, while Australia and Canada have universal health insurance policies that ensure citizens access to health care. United States is the only country presented here without universal health care, and a major part of health services are funded through private insurance schemes. However, the health services in the United States is under restructuring (the "Obamacare"). Zero vision of the patient safety is presented in Canada, England and Sweden, as part of goal-setting, but is concretised as measures within limited areas. Patient safety efforts has various forms. Several countries have both carried out national campaigns for patient safety and established reporting systems for adverse events. All of the countries have established long-term national programs. 

Country-Patient safety initiatives

Reporting systems:

  • Australia, Program: Yes
  • Canada Program à Campaignà, Program: Yes (medication)
  • Denmark, Campaign à Program/Campaign: Yes
  • England, Program à Campaign à Program: Yes
  • Scotland, Program: Yes
  • Sweden, Program: Yes
  • USA, Program à Campaign à Program: Yes 

Denmark has an on-going national campaign for patient safety. Sweden's campaign is limited to one region, but has a national effort based on implementation of a new patient safety law (2011-2014). Scotland has a patient safety program that now integrates with other quality work. In Australia, Canada and the United States the patient safety is clearly present, but the campaign form is not prominent. In England a campaign for increased involvement and information about patient safety is announced. In Australia, Canada, England and Scotland patient safety seems to be integrated in quality initiatives.

Building capacity and competence are mentioned as key prerequisites in order to reduce the extent of the patient's harm. In order to increase the capacity measures are taken to ensure competency in patient safety for health personnel. It is through education in all the health professions, but also by continuing professional education. Australia, Canada and the United States have certification of competence in patient safety skills.

Information about the funding of patient safety are available in Canada, it is more difficult to find information about Australia, England and Scotland. In Sweden They use financial incentive when implementing the new patient safety law. The use of economic incentives attached to outcomes, has been partly introduced in England, the United States and Sweden (pay for performance).

England has recently launched a number of quality indicators with targets within patient safety, the equivalent of what’s happening in Sweden. Canada and the United States started early with systematic evaluation of patient safety. In the United Kingdom one campaign is evaluated, and the new campaign in Denmark will be evaluated.

Discussion

Patient safety has been a priority area internationally for more than 10 years. The period is characterised by patient safety programs and larger initiatives as patient safety campaigns, in order to get the patient safety on the agenda. The adverse event reporting systems are still in process to find a common framework and a reporting format at the national level. England, Denmark and Sweden is, as far as we can see, the only countries that have managed to established systematic reporting at the national level. Patient safety appears to be increasingly integrated into local and regional quality work, but keeping the distinctive character of patient safety system perspective. An impression is a focus on building the knowledge and capacity locally, supported by the national programs. A common feature is that the reporting and learning systems appears to be a separate entity from other patient safety programs and campaigns. Likewise, local measurements in relation to the implementation of improvements on the one hand (often process measures), and aggregated patient safety measures seems to be detached processes. 

Conclusion

Efforts are taken to establish and run good adverse event reporting system, and systematic work with the analysis and lessons of the adverse events. Patient safety work is related to the different environment such as campaigns, reporting systems and measurements, it appears that the work on quality and patient safety to a greater extent be reconciled. There is a need for more knowledge about measurement methods, the importance of context, relationship to the quality of work in general and which methods that are best suited to increase patient safety (implementation).

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About this publication

  • Year: 2013
  • By: Norwegian Knowledge Centre for the Health Services
  • Authors Saunes IS, Ringard Å.
  • ISSN (digital): 1890-1298
  • ISBN (digital): 978-82-8121-637-2