As with any participant of the patient safety improvement community – I often read the perspectives of Dr. Peter Pronovost with interest. Alongside some patient safety science colleagues, Pronovost recently published a World Health Organization Bulletin entitled, “Changing the narratives for patient safety.” The full post is available here. This perspective argues that the way we speak about patient safety – the story we often tell – is in part responsible for the lack of progress made globally in reducing medical harm. Specifically, the article targets five false safety narratives.
5 False Safety Narratives:
- Patient harm is inevitable
- Clinicians, not systems, are responsible for safety
- Each organization should solve their patient safety problems alone
- Improvement will come by improving one process at a time through bounded projects
- Patients’ role in safety is limited to surveillance agents and victims
I hear these narratives often. I hear them brought up by healthcare executives trying to make sense of patient safety culture surveys. I hear them spoken by frontline leaders frustrated at the number of improvement targets. I hear the merits of these narratives discussed in various safety and quality councils. I completely agree these narratives can derail a safety improvement discussion as quickly as a surprise visit from the Joint Commission.
So, how do we change the conversation? Pronovost and colleagues argue for standardized safety metrics, collaborative systems design, deeper learning from other high risk industries, and engagement of academic institutions to build improvement capacity. These efforts are necessary, but require significant engagement globally from many different stakeholders. When faced with such a huge global challenge, it’s also important to consider what each of us can do to shift the conversation. So here is my response:
I commit to refuting these narratives when they are brought up.
Those of you who know me, know that I am not shy about speaking truth to hospital leaders about patient safety or safety culture. However, I need to keep a sharper eye out for false narratives and provide constructive narratives about solving these complex challenges.
I commit to providing organization specific data to refute these narratives.
Broad philosophical or theoretical discussions about safety and quality often fall flat with executive teams. Having a nuanced perspective on patient safety usually doesn’t break the frame of a strong opinion. Opinions are changed with data – and I commit to helping organizations collect and make sense of local data that will break these false narratives.
I commit to building a platform that integrates improvement.
Dr. Pronovost and colleagues call for a “new narrative for integrated system improvement.” To our clients (and our future clients) – let me be clear… The Beterra platform will continue to evolve to support your integrated improvement efforts. We will evolve as you do – and as we learn with you and from you – we commit to sharing that knowledge across our client base and building it into future versions of the platform.
These three commitments are my reaction to this perspective. What’s your reaction?
Above all – we wish you all success and wisdom in changing these narratives within your organization! Let us know if we can ever be of help!
Daniel – Beterra Co-founder