Collaborative patient safety program launched
Venture targets state agencies, hospital partners
The Agency for Healthcare Research and Quality (AHRQ) in Rockville, MD, and the Depart-ment of Veterans Affairs’ (VA) National Center for Patient Safety (NCPS) in Ann Arbor, MI, are collaborating on the Patient Safety Improvement Corps, a training program for state health officials and their selected hospital partners. During the first annual program, 50 participants will complete coursework in three one-week sessions at AHRQ’s offices.
Participants will analyze adverse medical events and near misses to identify the root causes of these events and correct and prevent them.
The overarching goal of the Patient Safety Improvement Corps, which is funded by AHRQ at approximately $7 million over four years, is to prevent harm to patients. "The genesis of the corps goes back to some meetings we had with state organizations in which we heard loud and clear the message that they really needed assistance on the front lines of improving patient safety," recalls Daniel Stryer, MD, director of the Center for Quality Improvement and Patient Safety at AHRQ. "It’s not adequate just to build a research base; people need to develop some skills for addressing threats to patient safety, errors, and harm from errors."
AHRQ felt, frankly, that "no one else could reach this audience," he continues. "We also felt that the VA was at the forefront of training in patient safety, so we wanted to build on this experience, combine it with our involvement in research and dissemination, and reach a broader audience." What the initiative is striving to do, Stryer explains, "is reach as many people, organizations, hospitals and, ultimately, patients as possible."
By going through representatives of state health departments, Stryer says the partnering organizations will provide indirect access to literally hundreds of hospitals and health care organizations, "providing us with leverage to amplify the impact we will have."
Toward that end, the corps has a partnership structure. "What we have done is ask for the representatives of the state to partner with representatives of local hospitals," he says. "They provide different viewpoints, experience, and also ensure that the training they are getting is really going to be applicable to local environments. That one organization will benefit, but the state health departments will also benefit from the partnership. This is a very important program grounded in reality."
Many of the session trainers are from the VA’s NCPS, says Stryer. Others will include AHRQ faculty and outside experts.
The training program for Wisconsin, which just recently was completed, appears to have been a success according to Myra Enloe, RN, MS, patient safety officer at the University of Wisconsin Hosp-ital and Clinics in Madison.
"Our state’s QIO, MetaStar Inc., represented the state [and its Department of Health and Family Services] in the program and chose us as a partner," she says. "I felt it was important; it seemed like a wonderful opportunity to really get some formal education in patient safety from some of the real experts in the field, and that it would benefit our organization in continuing its efforts to promote patient safety."
Having completed the course, she is convinced she made the right decision. "It was great — very worthwhile," Enloe says. "It was five days of education, with people from the VA’s [NCPS], who are considered leaders in the movement. It was also an opportunity to get to know other people who are in patient safety."
It was valuable for state organizations and hospitals to be brought together, she adds. "These are folks who don’t usually work together in this way." The trainers and participants spent a lot of time on root-cause analysis processes. "This was an opportunity to practice doing them in a little more structured, efficient, and probably more effective way than how we have done them in the past. One of the key things I took home is that they really involved senior leadership in root-cause analysis, and I find that to be a crucial factor."
As for the ultimate benefit of the state/hospital interface, Enloe contends the jury is still out. "I’m still trying to figure out how this will play out. But it will definitely help to raise some of the regulatory problems, as well as clinical issues, and provide a better understanding for both sides."
Need More Information?
For more information, contact:
• Agency for Healthcare Research and Quality, Rockville, MD. Web site: www.ahrq.gov.
• Myra Enloe, Patient Safety Officer, University of Wisconsin Hospital and Clinics, Madison. E-mail: [email protected].
The Agency for Healthcare Research and Quality (AHRQ) in Rockville, MD, and the Depart-ment of Veterans Affairs (VA) National Center for Patient Safety (NCPS) in Ann Arbor, MI, are collaborating on the Patient Safety Improvement Corps, a training program for state health officials and their selected hospital partners. During the first annual program, 50 participants will complete coursework in three one-week sessions at AHRQs offices.Subscribe Now for Access
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