Quality Improvement and Patient Safety: Systemic Approaches and Processes

There are dramatic problems with the quality of medical care and patient safety worldwide. Of 421 million annual hospital stays, approximately 42.7 million lead to adverse events. Patient safety (PS) is jeopardized by the behavior of individuals, the organization of workflows, and the design of work tools. In many case studies, human factors (HF) are cited as the cause in about 80% of preventable adverse events and patient accidents. HF does not describe a science, but unites several sciences, including engineering, work, and organizational psychology. Often, the importance of HF is reduced to incorrect behavior and its avoidance. Thus, the often lamented “name-blame-shame” culture is only superficially changed. However, if the response to errors is more training and “more effort”, the underlying mechanisms are ignored. This has various consequences for clinical leadership. It’s not just about technical solutions, but above all about a cultural change. Healthcare in the 21st century is characterized by increasing complexity and specialization. The following quote expresses this development in a pointed form: “Medicine used to be simple, ineffective, and relatively safe—today it has become complex, effective, and dangerous” (Chantler 1999). In 2018, the Lancet Global Health Commission, a coalition of WHO, OSCE and WB, as well as the US National Academies of Sciences, Engineering and Medicine, urgently appealed in three groundbreaking reports to improve the quality of care in health systems of poor and rich countries, to avoid adverse events and harm to patients, and to ensure universal healthcare in all countries, especially in low and middle income countries (Braithwaite et al. 2020).