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16/02/2011 L. Macchi 2011 ©
Review of approaches for safety management: available models and systems
SafetyAsset Project16-02-2011
16/02/2011 L. Macchi 2011 ©
Outline of the presentation
Where we were during last workshopThematic areas for patient safety management
Safety management model and Safety Management SystemsWhat are they?What are they for?
Safety Management Systems in Health care In Finland Abroad
What about other safety critical organisations?Concluding remarks for the development of SMS Practicalities from the project (report; publications; next steps…)
16/02/2011 L. Macchi 2011 ©
Outline of the presentation
Where we were during last workshopThematic areas for patient safety management
Safety management model and Safety Management SystemsWhat are they?What are they for?
Safety Management Systems in Health care In Finland Abroad
What about other safety critical organisations?Concluding remarks for the development of SMS Practicalities from the project (report; publications; next steps…)
16/02/2011 L. Macchi 2011 ©
Thematic areas for patient safety management
Management commitment and management safety understanding (e.g. prioritization, understanding of the management steering effects)
16/02/2011 L. Macchi 2011 ©
Thematic areas for patient safety management
Management commitment and management safety understanding (e.g. prioritization, understanding of the management steering effects)Structures of patient safety (organizing, responsibilities, roles, resources, reporting)The role of the patient / customer (autonomy, involvement) and patient focused care
16/02/2011 L. Macchi 2011 ©
Thematic areas for patient safety management
Management commitment and management safety understanding (e.g. prioritization, understanding of the management steering effects)Structures of patient safety (organizing, responsibilities, roles, resources, reporting)The role of the patient / customer (autonomy, involvement) and patient focused careProcess thinking (the way of doing things in addition to looking at the outcome)Information on patient safety (e.g. the level of patient safety) and personnel’s safety understanding (e.g. what is patient safety, how can one contribute to it)Different couplings (patient safety, occupational safety, information safety, economics etc)
16/02/2011 L. Macchi 2011 ©
Thematic areas for patient safety management
Management commitment and management safety understanding (e.g. prioritization, understanding of the management steering effects)Structures of patient safety (organizing, responsibilities, roles, resources, reporting)The role of the patient / customer (autonomy, involvement) and patient focused careProcess thinking (the way of doing things in addition to looking at the outcome)Information on patient safety (e.g. the level of patient safety) and personnel’s safety understanding (e.g. what is patient safety, how can one contribute to it)Different couplings (patient safety, occupational safety, information safety, economics etc)Organizational climate (e.g. openness, non-blaming)
16/02/2011 L. Macchi 2011 ©
Thematic areas for patient safety management
Management commitment and management safety understanding (e.g. prioritization, understanding of the management steering effects)Structures of patient safety (organizing, responsibilities, roles, resources, reporting)The role of the patient / customer (autonomy, involvement) and patient focused careProcess thinking (the way of doing things in addition to looking at the outcome)Information on patient safety (e.g. the level of patient safety) and personnel’s safety understanding (e.g. what is patient safety, how can one contribute to it)Different couplings (patient safety, occupational safety, information safety, economics etc)Organizational climate (e.g. openness, non-blaming)Development competence and organizational learningCompetence and training
16/02/2011 L. Macchi 2011 ©
Thematic areas for patient safety management
Management commitment and management safety understanding (e.g. prioritization, understanding of the management steering effects)Structures of patient safety (organizing, responsibilities, roles, resources, reporting)The role of the patient / customer (autonomy, involvement) and patient focused careProcess thinking (the way of doing things in addition to looking at the outcome)Information on patient safety (e.g. the level of patient safety) and personnel’s safety understanding (e.g. what is patient safety, how can one contribute to it)Different couplings (patient safety, occupational safety, information safety, economics etc)Organizational climate (e.g. openness, non-blaming)Development competence and organizational learningCompetence and training Communication and cooperation
16/02/2011 L. Macchi 2011 ©
Outline of the presentation
Where we were during last workshopThematic areas for patient safety management
Safety management model and Safety Management SystemsWhat are they?What are they for?
Safety Management Systems in Health care In Finland Abroad
What about other safety critical organisations?Concluding remarks for the development of SMS Practicalities from the project (report; publications; next steps…)
16/02/2011 L. Macchi 2011 ©
Safety Management Model
Patient safety management model represents the approach used to develop patient safety
16/02/2011 L. Macchi 2011 ©
Safety Management Model
Patient safety management model represents the approach used to develop patient safety
It addresses (e.g.): the analysis unit of patient safetythe understanding of patient safetythe concepts that are needed to develop patient safetythe means to develop patient safety the integration of safety management in the overall management the phenomena to be considered in the development of an organisational patient safety management system.
16/02/2011 L. Macchi 2011 ©
Safety Management Systems
Safety Management Systems (SMS) provide a systematic way to ensure the safe functioning of an organisation
16/02/2011 L. Macchi 2011 ©
Safety Management Systems
Safety Management Systems (SMS) provide a systematic way to ensure the safe functioning of an organisation
The objective of a SMS is to provide a structured management approachto control risks in operations, and to enhance the ability of the organisation to cope with situations that can lead to incidents and accidents
16/02/2011 L. Macchi 2011 ©
Safety Management Systems
Safety Management Systems (SMS) provide a systematic way to ensure the safe functioning of an organisation
The objective of a SMS is to provide a structured management approachto control risks in operations, and to enhance the ability of the organisation to cope with situations that can lead to incidents and accidents
SMS includes (usually) processes for:planningorganisingcommunicating providing direction for protection from risks reviewing and providing feedback
16/02/2011 L. Macchi 2011 ©
Outline of the presentation
Where we were during last workshopThematic areas for patient safety management
Safety management model and Safety Management SystemsWhat are they?What are they for?
Safety Management Systems in Health care In FinlandAbroad
What about other safety critical organisations?Concluding remarks for the development of SMS Practicalities from the project (report; publications; next steps…)
16/02/2011 L. Macchi 2011 ©
Finnish patient safety strategy
Promotion of patient safety is a part of the quality and risk management
Patient safety is dealt with from four perspectives: Safety cultureResponsibilityManagementLegislation
Patient safety is improved by quality and risk management. Hidden factors behind patient safety incidents should be disclosed before adverse effects emerge. Anticipation and analysis of different types of safety risks andintervention in them are important in the prevention of adverse events
16/02/2011 L. Macchi 2011 ©
Outline of the presentation
Where we were during last workshopThematic areas for patient safety management
Safety management model and Safety Management SystemsWhat are they?What are they for?
Safety Management Systems in Health care In Finland Abroad
What about other safety critical organisations?Concluding remarks for the development of SMS Practicalities from the project (report; publications; next steps…)
16/02/2011 L. Macchi 2011 ©
Examples from abroad: The Netherlands
Supporting all hospitals by implementing a patient safety management system so that they all have a certified system in December 2012
The Dutch approach:Develop basic requirements for the patient safety management systemDevelop material and training for hospitals to support implementation of SMSSupport hospitals in reducing preventable harm
Requirements for patient safety: LeadershipCommunicationEmployeesParticipation of patientsProspective risk analysisOperational control measuresChange-managementIncident reporting and retrospective risk analysisMonitoring of resultsImprovements of the safety of health care
16/02/2011 L. Macchi 2011 ©
Examples from abroad: United Kingdom
National Patient Safety Agency’s 7 steps for patient safety:
Step 1: Build a safety culture. Carry out an audit to assess safety culture.Step 2: Lead and support your practice team. Talk about the importance of patient safety; demonstrate you are trying to improve itStep 3: Integrate your risk management activity. Regularly review patient recordsStep 4: Promote reporting. Share patient safety incidentsStep 5: Involve and communicate with patients and the public. Seek patient views; Encourage feedback using patient surveysStep 6: Learn and share safety lessons. Hold regular Significant Event Audit meetingsStep 7: Implement solutions to prevent harm. Ensure that agreed actions are documented, actioned and reviewed, and agree who should take responsibility
16/02/2011 L. Macchi 2011 ©
Examples from abroad: AustraliaA SMS is interlinked with other activities for managing risk and is embedded in the
organisation’s culture.
A SMS is a systematic, explicit, and comprehensive process for managing the risks that patients face in a health care setting. A SMS has the following attributes:
the discovery and assessment of the hazards of particular operationsthe specification of how these hazards are to be managedwhat is to be done if things go wrong
Levels of accountability:CEOs and Executive: accountable for patient safety in their area of responsibility.Managers/Clinician Managers: accountable for actions in their work area, including the operations of their teamsHealth care Professionals: accountable for their own individual actions.Patients and their carers: assume a degree of responsibility for themselves to reduce their exposure to safety risks
16/02/2011 L. Macchi 2011 ©
Examples from abroad: CanadaThe Institute for Safe Medication Practices is established to:
collect and analysis ‘medication error’ reportsdevelop recommendations for the enhancement of patient safety
Specific goals:Review medication errors and to make recommendations to reduce the probability that such errors will happen againPublish and disseminate information in order to promote safe medication use and strategies for reduction of error-induced injuryParticipate in co-operative programs to provide education about adverse drug events and their preventionAct as consultants to institutions and other health-care settings on medication useDevelop educational and quality improvement assessment tools for healthcare professionals and institutionsProvide educational programs for university and health-professional constituents
16/02/2011 L. Macchi 2011 ©
Examples from abroad: Italy
Definition of roles in local agencies:Clinical risk manager: promoter of the clinical risk management culture and activities among cliniciansPatient safety manager: responsible for the implementation of the action plan and recommendations about clinical risk managementForensic medical doctor: responsible for the Observatory for claims
Building a Clinical risk management systemIdentification of risksAnalysis of clinical risks and safety management
Promoting campaigns for patient safetyFocus on well known risks for patient safety
Creating Clinical Risk management LaboratoriesIdentify the most critical activities in specific areas, where adverse events are particularly high
16/02/2011 L. Macchi 2011 ©
Outline of the presentation
Where we were during last workshopThematic areas for patient safety management
Safety management model and Safety Management SystemsWhat are they?What are they for?
Safety Management Systems in Health care In Finland Abroad
What about other safety critical organisations?Concluding remarks for the development of SMS Practicalities from the project (report; publications; next steps…)
16/02/2011 L. Macchi 2011 ©
Examples from other domains: HSE
Emphasis on the need to:Establish and maintain management controlPromote co-operation between individuals, safety representatives and groups Ensure the communication of necessary information throughout the organizationSecure the competence of employees
Requisites for control are:Formulating and developing policyPlanning, measuring, reviewing and auditing activities Ensuring effective implementation of plans and reporting on performance.
Components of the health and safety management system:Risk control systemsManagement arrangements Workplace precautions
16/02/2011 L. Macchi 2011 ©
Examples from other domains: aviation
The United States Federal Aviation Administration (FAA) SMS includes:
Safety Policy: requires the commitment of the top management to improve continually safety. It includes the definition of methods, processes and structures in order to meet the defined safety goals. Safety Risk Management: consists in the actuation of the formal process to describe the system and its functioning, to identify the hazards, to assess and analyse the risk and to control it. Safety Assurance: evaluates the effectiveness of implemented risk controls and the identification of new hazards. Audits, employeereporting, data analysis and system assessment are the most common tools. Safety Promotion: includes training, communication and other initiatives to promote, create and sustain mindfulness in the organisation.
16/02/2011 L. Macchi 2011 ©
Examples from other domains: nuclear
The International Atomic Energy Agency requires all nuclear installations to:establishimplementassesscontinually improve a management system.
Management system integrates safety, health, environmental, security, quality and economic elements
Safety is achieved and enhanced by:bringing together all the requirements for managing the organizationdescribing the planned and systematic actions necessary to provide adequate confidence that all these requirements are satisfiedensuring that health, environmental, security, quality and economic requirements are not considered separately from safety requirements.promoting and support a strong safety culture
16/02/2011 L. Macchi 2011 ©
Outline of the presentation
Where we were during last workshopThematic areas for patient safety management
Safety management model and Safety Management SystemsWhat are they?What are they for?
Safety Management Systems in Health care In Finland Abroad
What about other safety critical organisations?Concluding remarks for the development of SMS Practicalities from the project (report; publications; next steps…)
16/02/2011 L. Macchi 2011 ©
Remarks from the literature
A SMS is a business function of the organisation
A SMS is a systematic and organised approach to manage an organisationwith respect to safety
The purpose of a SMS is to achieve and maintain the necessary level of safety to ensure the functioning of an organisation
The SMS is concerned with managing the safety of the organisation’sactivities throughout the lifetime of the operation of the system
16/02/2011 L. Macchi 2011 ©
Remarks from the literature
A typical SMS (should) includes:A safety policy: a clear written statement of the organisation’s view, attitudes, and objectives with respect to safety in relation to the other business processes.Organisational arrangements to support safety: involves the organisation, supervision, recruitment, and training of staff to support thesafety policy and processes.A safety plan: involves elements of establishing standards and processes for safety, and conducting risk assessment and mitigation.A mean of measuring safety performance: processes and data are required in order to monitor the current and past safety performance.A mean of reviewing safety performance: to assess and understand safety performance against the safety objectives (e.g. incident investigation and safety surveys)A feedback loop to improve safety performance: making sure learnt lessons and changes for improvement, are properly accounted for by the organisation, and properly communicated to all relevant staff.
16/02/2011 L. Macchi 2011 ©
Concluding remarks
SMS is a collection of processes to manage an organisation
SMS has to be integrated in the management system
SMS is NOT a document
SMS has to be documented
SMS cannot be “copied” from other organisations
SMS have to be developed in the organisation taking into account its characteristics
SMS has to be integrated to management of the organisation
SMS aims at steering an organisation (NOT ONLY at protecting it from adverse events)
16/02/2011 L. Macchi 2011 ©
Concluding remarks
Safety management is more than assessing and eliminating risks
Safety management requires to enhance the prerequisites for safe work
Safety management model (the approach to safety) has to reflect this
Safety management model has to understand patient safety as a systemic phenomenon
Patient safety is something the organisation does
16/02/2011 L. Macchi 2011 ©
Outline of the presentation
Where we were during last workshopThematic areas for patient safety management
Safety management model and Safety Management SystemsWhat are they?What are they for?
Safety Management Systems in Health care In Finland Abroad
What about other safety critical organisations?Concluding remarks for the development of SMS Practicalities from the project (report; publications; next steps…)
16/02/2011 L. Macchi 2011 ©
Thank you for your attention.
Questions? Comments?
![Andrea Macchi Dipartimento di Fisica, Universita´ di … · arXiv:physics/0105017v4 [physics.plasm-ph] 26 Apr 2002 Two-surface wave decay Andrea Macchi∗, Fulvio Cornolti and Francesco](https://img.pdfslide.us/doc/110x75/5bba973709d3f2323f8dbe02/andrea-macchi-dipartimento-di-fisica-universita-di-arxivphysics0105017v4.jpg)
