Summary
The objective of this work package (WP4) of the SimPatIE-project was the development of a vocabulary and an internal indicator set for patient safety. This report describes the work done to develop the vocabulary.
The ESQH-office for Quality Indicators in Aarhus, Denmark was the lead partner of WP4. An expert group with European representatives of project partners, stakeholders and external experts was established for the achievement of the aims of WP4.
A literature search was performed to identify nationwide and international definitions of terms related to patient safety. Selecting and defining terms, and clarifying the concepts was done in a formalised consensus process in a sub-group to the expert group, interacting with the expert group. The work was executed using telephone conferences and mail correspondence, the sub-group came once together in the developmental process to deepen the work. The final draft of the vocabulary was sent to the expert group and two patients’ representative for comments. Comments were discussed in a telephone conference of the subgroup, alterations were made accordingly and the vocabulary finalised.
A vocabulary of 24 definitions of patient safety terms covering the domains: “Detection of Risks”, “Analysis of Risks”, “Resulting Actions” and “Failure Mode” was developed and accompanied by illustration overview of the relation of the five core terms of the vocabulary. The terms are available in English language on www.simpatie.org. The vocabulary is aimed at professionals e.g. risk managers, administrators and others working with patient safety.
The vocabulary provides a basis of achieving greater unity of patient safety work in Europe - especially it serves as a basis for applying patient safety evaluation tools of the toolbox of SimPatIE. We highly recommend the vocabulary and the vocabulary framework (Diagram 1) made accessible in the European countries. It should be translated into the European languages using a standardised method, and we recommend adequate local implementation strategies developed; health-care organisations, professional and scientific bodies and educational institutions should be made aware of the existence of the vocabulary, be encouraged to use it suggested so that the key elements can be put into everyday practice.
Introduction to WP4
Patient safety is an outcome of safe health care processes. While patient safety is the ultimate goal, it is a safer care environment in the cause of patient process of care which ultimately determines safety. Safety is one dimension of the broader construct of culture, which includes aspects of organisational and clinical culture, and sub cultures e.g. related to specialities and professions, and also cultures related to national, regional and local aspects.
Communication is vital to patient safety in many ways, thus supporting mutual understanding across cultures is essential in the general development of patient safety – a vocabulary with definitions of essential terms can facilitate communication between professionals in Europe.
The SImPatIE project was made possible by a grant from the European Commission on ‘Public Health/Directorate General for Health and Consumer Affairs in 2004’ (OJ 2004/C52, 27 February 2004). This report represents the views of its authors and the expert group of WP4. These views have not been approved by the European Commission and should not be relied upon as a statement of the European Commission.
Organisation of WP4
The ESQH-office for Quality Indicators in Aarhus, Denmark was the lead partner of this work package (WP4). It was lead by Prof. Jan Mainz, medical director of the Danish Institute for Quality and Accreditation in Healthcare, supported by Dr. Paul Bartels, medical director of the Danish Indicator Project. Overall project management and scientific work was executed by Master of Health Science Solvejg Kristensen.
The expert group consisted of representatives of project partners and external experts. Members of the expert group concerning the vocabulary were:
- MD, PhD. A. Bourek, University Center for Healthcare Quality, Masaryk University, Czech Republic
- Dr. I. Callanan, Vice President of the Irish Society for Quality and Safety in Healthcare
- Dr. K. Essinger, President, HOPE Subcommittee on Co-ordination (Appointed by HOPE)
- Dr. J. van Everdingen, chief medical officer of CBO (Appointed by CBO)
- Dr. M. Kallewaard of the Association of Medical Specialists (Appointed by CBO)
- Dr. J. Hansen, The Danish National Board of Health
- Dr. G. Maguerez (Appointed by HAS)
- MD, PhD R. Suñol, Director of Avedis Donabedian Foundation (FAD).
- Dr. Beth L., Director of the Danish Society for Patient Safety, Denmark
- Prof. Dr. med. G. Ollenschläger, Guidelines International Network (G-I-N).
Overall approach
The work of WP4 was initiated and coordinated by the ESQH-office for Quality Indicators in Aarhus.
The expert group came together February 2006 with the purpose of introducing SImPatIE and WP4. SimPatIE project manager Benno van Beek, CBO took part in the meeting. The following presentations were given:
- Overall SImPatIE Project Plan and Organisation, by project manager Benno van Beek, CBO
- Related Work of Work Package 5, by Dr. Georges Marguerez
- Introduction to Indicators Including Qualifications and Characterisation by Prof. Jan Mainz
- Proposed Schemes for Classification and Evaluation of Indicators by Prof. Jan Mainz
- Patient Safety Indicators, by Dr. Paul Bartels
- Specific Issues of Definition and Methodology and an Overview of Available Materials and Ongoing Work on Taxonomy/Vocabulary, by Dr. Paul Bartels
A detailed work plan for WP4 was established and tasks were assigned.
The overall working method in the expert group has been telephone conferences. Development has been initiated and decisions made in a formalised consensus process. The method of developing the indicators is described in details later.
Prior to the meeting of the expert group an extensive literature search was initiated using the search terms: “Patient safety”, “Vocabulary”, “Glossary”, “Taxonomy” and “Indicator”. PubMed http://scholar.google.dk/ were searched. The literature search was repeated and extended in the process of the work and finalised in august 2006. Details of the literature/back ground sources relating to the development of the vocabulary are given later.
