Perspectives on healthcare quality and safety

This chapter offers an introduction to the recently developed applied health science fields of patient safety, improvement, and implementation sciences. Healthcare is a high-risk activity because of the complexity of its systems and processes. Errors arise frequently and these can impact negatively on patients by causing adverse events. Errors and adverse events are generally attributable to defective systems for organizing care, which create conditions in which errors arise. This represents a failure of risk management. Patient safety science takes a scientific approach to understanding why errors occur and how to prevent their occurrence or minimize their impact. Learning from analysis of patient safety incidents, through root-cause analysis, enables an organization or service to learn and avoid repeating similar failures in the future. Patient safety incidents represent one aspect of the wider problem of poor-quality care. Improvement science offers standardized tools and measurements that can be used to monitor and improve healthcare delivery. The Model for Improvement employs repeated Plan–Do–Study–Act (PDSA) cycles to quantify problems and to develop and test potential solutions. Engagement with stakeholders is an essential part of this process. Implementation science can contribute by providing methods to promote the uptake of new research evidence into healthcare practice. It can address the second translational gap by facilitating the widespread adoption of strategies for improving health-related processes and outcomes, and advancing knowledge on how best to replicate intervention effects from trials into real-world settings. These new scientific fields provide well-established approaches to addressing some of the key problems arising in healthcare. Modern public health needs to reap the benefits of these newly emerged sciences to address the burden of adverse events and harm that arises in the delivery of healthcare and to promote evidence-based practice.