September 17, 2019, is the first World Patient Safety Day. Recognizing patient safety as a global health priority, WHO and member countries are launching a global campaign to create awareness and commitment to making health care safer. In his video message, the Director-General of WHO Dr. Tedros Adhanom Ghebreyesus calls on: policymakers to make patient safety a national priority, researchers to generate more evidence about how to keep patients safe, and the health care industry to generate innovations and technologies to help avoid patient harm. The time is ripe for researchers across the globe to answer this call with a moonshot for health services research (HSR) that inspires new methods and initiatives to improve patient safety.
HSR has much to offer to the field of patient safety. Conceptual models, an essence of good HSR, help understand and address the underlying issues, complexity and “basic science” of patient safety. HSR has generated evidence about the problem and developed and tested solutions. However, preventable harm has persisted and much more is needed not only to measure the burden of different types of patient safety events across settings but also to tackle emerging safety threats, and how to mitigate these threats before they lead to harm. Solutions need to be implemented and evaluated to ensure widespread effective adoption. We suggest at least three considerations for HSR to prepare for such a moonshot and go beyond business as usual.
More Partnership Research Models
Effective strategies to coordinate activities between researchers and stakeholders who use their research are few. Patient safety improvements require researchers to go beyond publishing papers and work closely with health care organizational leaders, clinicians, policymakers and patients. True partnered research occurs when operational partners are involved in design, planning and execution, and where partners can help define barriers and challenges to improvement. For instance, in a recent project, the research group led by blog post author Dr. Singh is partnering with the Institute for Healthcare Improvement and safety leaders on the ground to develop guidance that informs organizational leaders what actionable steps they can take to pursue high reliability in diagnostic safety. One area where a close partnership model will be most useful is patient safety measurement where researchers must overcome methodological challenges and help to develop robust metrics that can lead to improvement. Another key partnership is with patients –engaging them in design of research studies and measures of success, including patient-reported outcome measures. Ensuring that research is answering safety questions that truly matter to patients is critical.
More Impact from HSR
Traditional models of HSR success include publications and grants. However, HSR should create more impact on patient care, policy and clinical practice related to patient safety. In the Houston-based research Center of Innovation, measures of impact for scientific papers are defined using three criteria, any of which leads to the paper being inducted in a Hall of Fame. These criteria include:
- journal impact factor of >12, or
- cited at least 125 times, or
- Impacted clinical guidelines, health policy, or reports from national and international bodies such as National Academies, CMS, IHI, NQF, CDC, and WHO (most common reason for induction).
In addition, delivery system impact that isn’t necessarily tied to a scientific paper is captured in a separate ‘Delivery System Impact Hall of Fame’ for tools, products, policy impacts, guidelines or innovations that result from research. Our center’s experience tells us that this recognition motivates health services researchers to build stronger ties with health care stakeholders and policymakers to help translate research evidence into impact. This model is a win-win for all parties. For instance, both of us were involved in developing IHI’s Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era, that leveraged research evidence and health care system experiences to propose a nine-step, closed-loop safe referral process that stakeholders are now working to implement.
More Multidisciplinary Research and Implementation Centers of Excellence
Multidisciplinary science is essential to understand the complexity of safety as well as developing and testing solutions but patient safety research has been drastically underfunded. Other than AHRQ and VA, few federal stakeholders have supported multidisciplinary safety research. This research requires a unique understanding of multidisciplinary macro and microsystem constructs to solve cross-cutting and disease-agnostic problems inherent in safety improvement. In addition to broader funding streams, more centers of excellence are needed globally that leverage multidisciplinary teams that use different technical, social, psychological, organizational and clinical perspectives to synergistically understand and impact complex sociotechnical safety problems. One model is the VA National Center for Patient Safety that funds dedicated patient safety centers of excellence nationally that focus on research and implementation activities and promote organization-wide learning, including Houston’s Diagnosis Improvement Safety Center (DISCovery) that has worked on diagnostic errors since 2007. Multidisciplinary research teams could also embed themselves in health systems to create learning labs to understand safety problems, advance the science, and pilot-test improvement strategies.
We are optimistic that the first World Patient Safety Day will mark a resurgence of HSR for patient safety improvement. The HSR community could have a tremendous impact on helping prevent harm across the globe. In sum, an HSR moonshot could lead us from a “Bronze Age of rudimentary tool development to a Golden Era of vast improvement in patient safety.”