IMPROVING THE QUALITY

OF HEALTH SERVICES:
HOW TO OPTIMIZE
PATIENT SAFETY IN
HOSPITAL Cebu Normal University
Philippines
International Community Service Program
between UKHS, RSUD Wates, Yogyakarta
and Cebu Normal University, Philippines MA. MAYLA IMELDA M. LAPA
RN, MN, DScN (c)
Email: lapam@cnu.edu.ph
Faculty, College of Nursing
Presidential Assistant for Quality Assurance
 QUALITY
“doing the right thing at the right time for
the right person and having the best
possible result”

CONTINUOUS QUALITY
QUALITY CARE
IMPROVEMENT
provision of safe, effective, patient
centered, timely, efficient,
and equitable care
 PATIENT SAFETY
health care discipline that emerged with the
evolving complexity in health care systems
resulting in rise of patient harm
in healthcare facilities

CONTINUOUS QUALITY EMPHASIS

IMPROVEMENT
• System of Care Delivery: prevent errors, learns
from errors that occur, built on a culture of
safety
• Involved health care professionals,
organization, patient
 SOCIETY
ACCRE PATIEN
Patient safety: A shared AGENCIES T

responsibility
PROF INDIV
ASSO NURSE
Patient
safety
G&L NURSE
BODIES ED

NURSE
PHYSICI
AD
ANS NURSE
RES
Ballard, K (2003)
 SOCIETY
ACCRE PATIEN
Patient safety: A shared AGENCIES T

responsibility
PROF INDIV
ASSO NURSE
Patient
safety
G&L NURSE
BODIES ED

NURSE
PHYSICI
AD
ANS NURSE
RES
 SOCIETY
ACCRE PATIEN
Patient safety: A shared AGENCIES T

responsibility
PROF INDIV
ASSO NURSE
Patient
safety
G&L NURSE
BODIES ED

NURSE
PHYSICI
AD
ANS NURSE
RES
 SOCIETY
ACCRE PATIEN
Patient safety: A shared AGENCIES T

responsibility
PROF INDIV
ASSO NURSE
Patient
safety
G&L NURSE
BODIES ED

NURSE
PHYSICI
AD
ANS NURSE
RES
 SOCIETY
ACCRE PATIEN
Patient safety: A shared AGENCIES T

responsibility
PROF INDIV
ASSO NURSE
Patient
safety
G&L NURSE
BODIES ED

NURSE
PHYSICI
AD
ANS NURSE
RES
 SOCIETY
ACCRE PATIEN
Patient safety: A shared AGENCIES T

responsibility
PROF INDIV
ASSO NURSE
Patient
safety
G&L NURSE
BODIES ED

NURSE
PHYSICI
AD
ANS NURSE
RES
 SOCIETY
ACCRE PATIEN
Patient safety: A shared AGENCIES T

responsibility
PROF INDIV
ASSO NURSE
Patient
safety
G&L NURSE
BODIES ED

NURSE
PHYSICI
AD
ANS NURSE
RES
 SOCIETY
ACCRE PATIEN
Patient safety: A shared AGENCIES T

responsibility
PROF INDIV
ASSO NURSE
Patient
safety
G&L NURSE
BODIES ED

NURSE
PHYSICI
AD
ANS NURSE
RES
 SOCIETY
ACCRE PATIEN
Patient safety: A shared AGENCIES T

responsibility
PROF INDIV
ASSO NURSE
Patient
safety
G&L NURSE
BODIES ED

NURSE
PHYSICI
AD
ANS NURSE
RES
 SOCIETY
ACCRE PATIEN
Patient safety: A shared AGENCIES T

responsibility
PROF INDIV
ASSO NURSE
Patient
safety
G&L NURSE
BODIES ED

NURSE
PHYSICI
AD
ANS NURSE
RES
 SOCIETY
ACCRE PATIEN
Patient safety: A shared AGENCIES T

responsibility
PROF INDIV
ASSO NURSE
Patient
safety
G&L NURSE
BODIES ED

NURSE
PHYSICI
AD
ANS NURSE
RES
Why patient safety matters?

Every year, millions of patients suffer injuries or die

because of unsafe and poor-quality health care.
Many medical practices and risks associated with
health care are emerging as major challenges for
patient safety and contribute significantly to the
burden of harm due to unsafe care.
The burden of harm? (WHO)
Medication errors
• Leading cause of injury and avoidable harm in healthcare setting
• Cost estimated US$42B annually

Health care-associated infections

• 7 out of 100 hospital admission in high income countries
• 10 out of 100 hospital admissions in middle to low-income countries
• Some infections are life - threatening
 The burden of harm? (WHO)

Unsafe surgical care procedures

• 25% of patients undergoing surgery suffer complications
• 7M patients suffer significant complications annually
• 1M of whom die during or immediately following surgery

Unsafe injections practices

• transmit infections, including HIV and hepatitis B and C, and
pose direct danger to patients and health care workers
• estimated 9.2 million years of life are lost to disability and death
worldwide
The burden of harm? (WHO)

Diagnostic errors
• occur in about 5% of adults in outpatient care settings
• More than 50% have the potential to cause harm

Unsafe transfusion practices

• expose patients to the risk of adverse transfusion reactions and
the transmission of infections
• average incidence of 8.7 serious reactions per 100 000
distributed blood components
The burden of harm? (WHO)
Sepsis
• Not diagnosed early enough to save a patient’s life
• Often resistant to antibiotics, thereby rapidly lead to deteriorating
clinical conditions
• Affecting estimated 31 million people worldwide and causing over 5
million deaths per year

Venous thromboembolism (blood clots)

• one of the most common and preventable causes of patient harm
• Contribute to 1/3 of the complications attributed to hospital admission
• Annual estimate: 3.9 million cases in high-income countries and 6
million cases in low- and middle-income countries
 Clear
Policies

Effective
Leadership Data to drive
involvement safety
of patients Capacity improvements
in their care

Skilled health
care
professionals

OPTIMIZING PATIENT SAFETY

 Leadership
Clear • Cornerstone to success to any project
Policies or program
• Effective leaders lead by example, value
a strong work ethic, and demonstrate a
Effective commitment to the mission of an
involvement Leadership Data to drive institution or department beyond that of
safety self-preservation
of patients Capacity improvements
in their care • Determines organizational priorities and
can funnel resources toward important
safety initiatives.
• promote a positive organizational
Skilled health
care climate that contribute to higher job
professionals satisfaction among employees,
decreased burnout, fewer medical
errors, and an overall improved culture
OPTIMIZING PATIENT SAFETY of safety
 Risk – based approach
Clear • help avoid unnecessary situations
Policies • establishment of mechanisms that
support effective responses to
actual occurrences
Effective • ongoing proactive reduction of risk
involvement Leadership Data to drive that could lead to patient safety
safety occurrences
of patients Capacity improvements
in their care • integration of patient safety
priorities into the new design and
redesign of all relevant
organizational processes,
Skilled health
care functions and services
professionals

OPTIMIZING PATIENT SAFETY

 Patient – centered care
Clear Shared medical Hospital wide patient
Policies information safety activities

Early detection of threats Human factors approach

to patient safety
Timely and full
Effective disclosure of adverse
Leadership Data to drive
involvement safety events
of patients Capacity improvements
Patient advocacy
in their care
Patient safety education Patient safety
and training information distribution
Skilled health Building just and safe
care culture
professionals Hospital patient safety
Patient safety manual
policy disclosure

OPTIMIZING PATIENT SAFETY

 Clear “To Err is human”
Policies • Measuring patient safety
• Structures = how care is
organized
• Processes = what is
Effective
involvement Leadership Data to drive done to the patient
safety • Outcomes = what
of patients Capacity improvements
in their care ultimately happens to
the patient
Retrospective chart
Voluntary error
review
Skilled health reporting
care Automated
professionals surveillance Patient reports

OPTIMIZING PATIENT SAFETY

 Clear
Policies
• Training of healthcare
professionals on preventive
skills in addition to clinical and Effective
curative competencies Leadership Data to drive
involvement safety
of patients Capacity improvements
in their care
• Integration of patient safety in
the curriculum
Skilled health
care
professionals

OPTIMIZING PATIENT SAFETY

 Enlisting patients in
Clear
detecting adverse Policies
events

Empowering patients Effective

Leadership Data to drive
to ensure safe care involvement safety
of patients Capacity improvements
in their care
Emphasizing patient
involvement as a
Skilled health
means of improving care
the culture of safety professionals

OPTIMIZING PATIENT SAFETY

 Systems Approach/Systems Thinking

• applies scientific insights to understand the elements that influence

health outcomes; models the relationships between those elements;
and alters design, processes, or policies based on the resultant
knowledge to produce better health at lower cost

• dependent not only on the knowledge, skills and behaviors of the

front-line workers, but also how the workers work together in the
particular work environment, which itself is usually part of a larger
organization
References
Gonzales, R; Bretana, R; and Chaveco, Y. 2017. A risk-based integrated management for
patient safety and quality in healthcare services. Retrieved
https://www.researchgate.net/publication/315860917_A_risk-
based_integrated_management_for_patient_safety_and_quality_in_healthcare_services

Kaplan, G; Bo-Linn, G; Carayon, P; et. al. 2013. Bringing a Systems Approach to Health.
Retrieved https://nam.edu/perspectives-2013-bringing-a-systems-approach-to-health/

World Health Organization. n.d. World Health Organization Safety Curriculum. Retrieved
https://www.who.int/patientsafety/education/curriculum/who_mc_topic-3.pdf

Bugajneko, O. 2021. Systems Thinking in Healthcare. Retrieved

https://study.com/academy/lesson/systems-thinking-in-healthcare.html
References
PSNet. 2019. Patient engagement and safety. Retrieved https://psnet.ahrq.gov/primer/patient-
engagement-and-safety

AlAraby, S; Ra’oof, R; and Alkhadragy, R. 2018. Learning of Patient Safety in Health

Professional Education. Retrieved https://www.intechopen.com/chapters/62229

Trainer, B; Dayal, R; Agarwala, A; and Pukinas, E. 2020. Effective Leadership and Patient
Safety Culture. Retrieved https://www.apsf.org/article/effective-leadership-and-patient-safety-
culture/

Osaka University Hospital. n.d. Hospital Policy for Patient Safety and Quality Care. Retrieved
https://www.hosp.med.osaka-u.ac.jp/english/outline/basicpolicy.html

PSNet. 2019. Measurement of Patient Safety. Retrieved

https://psnet.ahrq.gov/primer/measurement-patient-safety
References
Kohn, K; Corrigan, K; Donaldson, M. 2005. To Err is Human. Retrieved
https://psnet.ahrq.gov/issue/err-human-building-safer-health-system

World Health Organization. 2019. Patient Safety. Retrieved https://www.who.int/news-room/fact-

sheets/detail/patient-safety

Ballard, K. 2003. Patient Safety: A Shared Responsibility. Retrieved

https://pubmed.ncbi.nlm.nih.gov/14656198/

Mitchell, P. 2008. Defining Patient Safety. NCBI Bookshelf. A service of the National Library of
Medicine, National Institutes of Health.

Scanlon, M; Karsh, B; and Saran K. n.d. Risk – based Patient Safety Metrics. Retrieved
https://www.ncbi.nlm.nih.gov/books/NBK43628/