Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families
Implementing the strategies will be like any quality or process improvement project. It requires commitment, leadership, and planning. The Agency for Healthcare Research and Quality provides tips for facilitating the quality improvement process in its Ambulatory Care Improvement Guide.
Step 1. Identify a Practice Champion and Secure Leadership Support
Strong leadership and staff engagement are important to any successful process improvement program.
Identify a practice champion
A practice champion is needed who can lead the implementation efforts. The practice champion should be dynamic and respected. The champion must work on team building and provide technical support for implementing the strategies. You may want to identify champions from both the administrative and clinical staff to encourage active engagement from all perspectives.
Secure leadership support
Strong leadership support is important to any successful patient safety improvement activity. Practice champions should orient leadership to:
- The scope of the problem of patient safety in primary care in general and the practice specifically.
- Available strategies to overcome patient safety challenges.
An infographic (PDF, 316 KB) is available for the practice champion to use when seeking leadership support.
Step 2. Select the Strategies To implement
Review the Guide strategies and select the strategy or strategies that address key patient safety threats for your practice. Use the selection guide to help guide your decisions.
Step 3. Plan Your Implementation Process
Once you have identified and prioritized the strategies for implementation, the next step is designing and planning a successful implementation.
- Identify your team. Even the strongest practice champions cannot do it alone. A small multidisciplinary team can help the practice champion make important decisions about strategies, timeline, and evaluation metrics.
- Set a reasonable timeline. Successfully implementing a sustainable practice improvement takes dedication and time. Multiple strategies should not be implemented at the same time. Each strategy should be implemented for at least 3 months before starting the next implementation. This approach will give the practice time to deploy the intervention and evaluate progress without distraction.
Allow flexibility for more complex changes that may require staff retraining. More complex strategies, such as the Warm Handoff Plus, may require longer implementation and adoption cycles than simpler strategies.
- Determine a standardized implementation process. There is no one best approach to planning, implementing, and evaluating quality improvement strategies. If you already have an established approach for practice improvements, use this approach.
A widely used approach for process improvement planning is the Model for Improvement.i This approach seeks to accelerate change improvement efforts through a series of Plan-Do-Study-Act (PDSA) cycles. Each rotation of the cycle results in improvements to the process, and each revision of the process requires additional measurement and evaluation.
Step 4. Design Your Implementation
The practice champion will lead the implementation team through the process of designing the implementation of the selected strategies.
- Use the Implementation Quick Start Guides. Each strategy has implementation guidance specific to that strategy within the Implementation Quick Start Guide. These Quick Start Guides are meant as the starting point for your implementation and should help you plan your strategy for adopting each intervention. The Guide appendixes also provide strategy-specific implementation guidance.
Step 5. Make Patients and Family Members Aware of the Changes
Inform patients and their families about what the practice is implementing and what the patients’ and families’ roles are in the process. Talk with patients about the importance of engagement and the practice’s engagement efforts and reinforce the patients’ and family members’ roles in ensuring safe and effective care.
Step 6: Evaluate Implementation Effectiveness
Recognize your team’s efforts and successes
Talk about progress every chance you get. Tell success stories about using the intervention. Celebrate clinician and practice staff wins and publicly recognize efforts to improve patient safety. Ensure that the success of the interventions is seen in every aspect of your practice to help the changes gain solid footing.
Establish evaluation measures
There are several things to consider when selecting measurements to assess the effectiveness of any process improvement implementation:
- Identify stakeholders and their data needs. This group includes internal stakeholders (e.g., patients, clinicians, practice staff, administrators, and leaders) and external stakeholders (e.g., payers, regulators). Ideally, you should select evaluation measures that meet the information needs of both internal and external stakeholder groups.
- Identify global patient safety and patient and family engagement outcomes. These may include measures of patient safety or patient and family engagement tracked over time. These would be conducted less regularly than process implementation measures. Be sure to conduct a baseline evaluation of your global outcome measures to fully assess the impact of your practice changes.
- Identify strategy-specific outcomes and implementation processes. Establish strategy-specific measures on both outcomes and processes to examine implementation success. These measures are often obtained through observation and self-report. The process-related measures should focus on whether the implementation was successful and how and why the implementation was successful (or not).
Monitor the impact of patient safety and patient engagement activities
Several surveys can assist office practices in monitoring the impact of patient safety and patient engagement activities at the practice level. The surveys and measures provided here are recommendations. You should select the measures that best reflect your implementation and practice environment.
- AHRQ Medical Office Survey on Patient Safety Culture. This AHRQ-sponsored survey is designed specifically for outpatient medical office providers and staff and asks for opinions about the culture of patient safety and healthcare quality in medical offices.
- Clinician & Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS). This survey assesses patients’ experiences with healthcare providers and staff in doctors’ offices.
- CG-CAHPS Health Literacy Item Sets. The CAHPS Health Literacy Item Sets focus on assessing providers’ activities to foster and improve patients’ health literacy. Health literacy is commonly defined as patients’ ability to obtain, process, and understand the basic health information and services they need to make appropriate health decisions. While health literacy depends in part on individuals’ skills, it also depends on the complexity of health information and how it is communicated.
- Patient measures of patient safety. Recently, several new measures of patient safety from the patient’s perspective have been developed. These include:
- Primary Care Patient Measure of Safety (PC PMOS), discussed in an article in BMJ Quality & Safety at http://qualitysafety.bmj.com/content/25/4/273.
- Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC), discussed in an article in Annals of Family Medicine at http://www.annfammed.org/content/14/3/253.full.
- Patient Experience Assessment, part of the guide Improving Your Laboratory Testing Process, available at https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/lab-testiing/lab-testing-toolkit.pdf.
i Institute for Healthcare Improvement. How To Improve. http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx. Accessed March 28, 2018.