are just two examples of focused collective efforts for improving outcomes. The IHI Triple Aim has three primary goals for health care – improve population health, reduce costs, and improve the quality of care – all of which align with the 2001 IOM STEEEP model. To address concern for the health care workforce, the Triple Aim was replaced with the Quadruple Aim as a more comprehensive model (Bachynsky, 2020).
The Patient Safety Movement Foundation (https://patientsafetymovement.org) is a nonprofit professional and consumer organization with the aim to “prevent the preventable.” The goal to achieve zero deaths from preventable health care harm is also endorsed by the International Society for Quality in Health Care (ISQua; Goldstein, 2019) and 4,793 hospitals in 48 countries. Others question whether the focus on achieving zero will distract from creating total system safety (Thomas, 2020).
Bold progress will require bold action and collaboration across the world. The WHO issued the Global Patient Safety Action Plan for 2021–2030 (WHO, 2021). The plan requests all member states to recognize the crisis of patient safety by establishing policies and actions to reduce preventable harm. The report issued a set of policy recommendations for global collaboration and coordination to push forward an agenda for patient safety and quality. WHO also established a yearly World Patient Safety Day, celebrated with informative webinars and education sessions to highlight preventable harm.
The formation of the Interprofessional Education Collaborative (IPEC, 2011) is a major achievement impacting quality and safety. Six health care professions collaborated in developing four domains of interprofessional education: values and ethics, roles and responsibilities, communication, and teamwork and team‐based care (Figure 1.2). The competencies are commensurate with the QSEN competencies. The IPEC competencies were updated in 2016 to include interprofessional collaboration as the overarching domain encompassing the four competencies (IPEC, 2016), now endorsed by more than 16 health care disciplines. The movement for interprofessional education and practice led to US federal funding to establish the National Center for Interprofessional Practice and Education (https://nexusipe.org). This is a robust clearinghouse for interprofessional practice and education, which are increasingly linked to quality safe care, better care, added value, and healthier communities (Neuhaus et al., 2020). Interprofessional care, quality and process improvement, and population health management are ways to align education and practice with quality safe care across all aspects of health care (Brandt et al., 2014; see Chapter 14). These competencies also cross‐walk with the widely disseminated TeamSTEPPS curriculum, made available by AHRQ to develop four main themes: Leadership, Communication, Mutual Support. and Teamwork (https://www.ahrq.gov/teamstepps/index.html). Each of these has been linked to developing safety culture, and together these competencies are embedded in the QSEN competencies and discussed later in the chapter.
Figure 1.2 Interprofessional competency domains for education and practice.
Source: Modified from Interprofessional Education Collaborative Expert Panel (IPEC), 2011, Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. Washington, DC: Interprofessional Education Collaborative.
Many nursing organizations have identified and developed programs to improve quality and safety. For example, the American Association of Critical‐Care Nurses (AACN; www.aacn.org) developed multiple approaches, including a program on healthy work environments focused on teamwork and collaboration. The Nursing Alliance for Quality Care (see Chapter 2) created one organized nursing voice to ensure that (a) patients receive the right care at the right time from the right professional; (b) nurses actively advocate and are accountable for consumer‐centered, high‐quality health care; and (c) policy‐makers recognize the contributions of nurses in advancing consumer‐centered, high‐quality health care.
The American Nurses Association also established the National Database of Nursing Quality Indicators in 1998, which maintains data on sustained improvement in a designated nursing‐sensitive indicator such as staffing, hospital‐acquired pressure ulcers, falls and prevention of injury from falls, staff satisfaction, and pediatric and psychiatric mental health data (see Chapter 2). The Magnet recognition program standards recognize nursing leadership, continuous quality improvement, and organizational culture. In a bold move that helped transform nursing education, prelicensure and graduate nurse competencies were developed by the QSEN project (see Chapter 3).
The Compelling Case for Quality and Safety: A Systems Approach
Berwick and Cassel (2020) describe the growth of quality in health care over the past 50 years and the work that remains to be done. Striking a balance between accountability and a culture of growth and learning fosters improvement. Quality and safety involve more than individual accountability; workers must cope with poorly designed protocols and systems. Reducing health care harm is best achieved by preventing errors before they happen. Organizational safety culture builds an environment that helps eliminate discrepancies in care that result from provider actions in delivering care, such as daily safety huddles or briefings to identify and manage high‐risk situations (Meyer, Hill, and Baker, 2020). The compelling case for quality applies safety science built on a systems approach that leads to a culture of safety incorporating just culture, high reliability, and improvement science.
Safety Science: Building a Safety Culture
With no coordinated reporting and dissemination on error trajectory, health care has lagged behind other high‐risk industries in creating a safety culture. Aviation has focused on safety for more than 50 years, with a significant reduction in fatalities. Health care has adopted and adapted principles and approaches from aviation as well as other high‐risk, high‐reliability organizations that have similar characteristics, such as intermittent, intense tasks that demand exacting responses (Oster and Braaten, 2020; www.ahrq.gov). One central approach is having a reliable reporting system to systematically collect data on sentinel events for review through standardized processes, and systems that can monitor and improve system safety (Vaughn et al., 2019).
High‐risk industries showing dramatic improvements in quality and safety, however, are supported by a designated agency that sets and communicates goals, brings visibility, and systematically collects and analyzes error reports for root cause analysis, such as the Federal Aviation Association and the National Transportation Safety Board, who issue regulations and investigate aviation events. Even though the 2001 IOM report recommended it, health care still lacks a designated safety agency. Numerous agencies promote the safety and quality agenda, but none is a collection point for analyzing safety or quality data with the goal of sharing results widely, such as share safety alerts and best practices for all settings. The Joint Commission does set regulatory standards and the National Patient Safety goals, but not all hospitals subscribe to The Joint Commission. Chapter 2 offers a summary of federal, regulatory, professional, and consumer agencies and organizations with a safety and quality agenda.
Safety science embraces an organizational framework to minimize risk of harm to patients and providers
