1. What is patient safety?
Authors: SM Smorenburg, J Kievit, JJE van Everdingen, and C Wagner
The following text is a summary of the corresponding chapter, in:
the 'Patient Safety Toolbox publication.
For an example of the complete chapter as published, see here (pdf-file).
Summary
Safety in health care can be improved and important lessons can be learned from other public sectors.
What makes the safety issue in health care more difficult is that the boundary between avoidable and unavoidable adverse effects in medical practice is a grey area. Incidents, errors and other shortcomings in the care process are not the only source of risk of health loss in medicine. Diseases and disorders, whether in combination with comorbi-
dity or not, bring with them significant (inherent medical) risks. Medical interventions too, even carried out perfectly, are not without risk. It is the task of the professional, from his expertise and understanding for the needs and wishes of the patient, to make responsible decisions and choices. Doctor and patients are aided by disciplines such as evidence-based medicine, medical decision-making and Technology Assessment, and guidelines.
Patient safety focuses on other risks, on the (potential) loss of health that is related to incidents, errors, communi-
cation disorders and other failings in the care process. These process risks are often insufficiently considered in the inherent risk calculations mentioned above. That the shortcomings in health care practice can lead to dramatic and unnecessary loss of health is a good reason for putting this subject, which has been clearly underexposed for a long time, back into the spotlight. In doing so, it is important to bear in mind the above-mentioned distinction; if we fail to do that, then patient safety could become all encompassing and thus an empty concept.
Safe care, therefore, is not the same as risk-free care, but means eliminating the risks resulting from human, tech-
nical and/or organisational inadequacies in the process of delivering care as far as possible. The challenge lying ahead of us is therefore to practice our work without creating public expectations that all risks can be completely eliminated. That is the real challenge, which will gain force if we keep a clear focus. Patient safety must not be reduced to the umpteenth hype, it is far too important for that.
