About the Project

An Emerging Roadmap for Patient Safer Culture

Strategies to Improve Perinatal Care

Medical errors are a leading cause of death
Every year more hospital patients die from medical errors than from car crashes, breast cancer, or AIDS. Medical errors have recently been estimated to be the third leading cause of death in the U.S. Since efforts to improve patient safety began in earnest in 2000, some areas of healthcare are safer, but errors and preventable patient harm remain far too frequent across all healthcare areas.

Perinatal safety is of particular concern
Although the majority of childbirths in the US result in healthy infants and mothers, serious adverse events are occurring at steadily increasing rates, resulting in devastating outcomes for infants, mothers and families. According to the Centers for Disease Control (CDC), there were 17.2 deaths per 100,000 live births in 2015, compared to 7.2 deaths per 100,000 live births in 1987.  Pregnancy-related complications result in increased days in the hospital and are about 50% as costly as uncomplicated births, accounting for $17.4 billion in annual US hospital costs. Some events are unavoidable or have increased risk due to pre-existing conditions; however, estimates suggest that 30% to 60% are preventable. Neonates are particularly vulnerable to medical errors. With reported rates as high as 74 neonate events per every 100 patients, 56% or those are considered preventable.

Improvement requires a “total systems approach” and “culture of safety”
The National Patient Safety Foundation concluded that a “total systems approach” is required to improve perinatal outcomes, and that leadership must establish a “culture of safety.”  Experts agree that improving patient safety will require a transformation of the culture of the healthcare industry.

The term patient Safer Culture refers to the values, norms, and beliefs about the role organization and employees play in ensuring positive patient health outcomes. A positive patient Safer Culture may be associated with fewer adverse events in hospitals.  Culture dictates healthcare leader and provider behavior and attitudes, and it sets the social rewards or punishments associated with specific actions.

Pre-existing frameworks have been incomplete and ineffective
Existing frameworks fail to distinguish factors that influence Safer Culture from Safer Culture itself, or the behaviors and health outcomes that result from a Safer Culture. These frameworks also fail to include all the known factors related to a safe culture. Given these limitations, efforts to improve Safer Culture have met with mixed results. For example, current improvement efforts begin with baseline measurements that use surveys of clinicians that only measure attitudes and perceptions — the safety climate. But Safer Culture assessment requires a more comprehensive assessment including not only the attitudes and perceptions (climate), but also the behavioral norms, values, and assumptions.

Introducing an evidence-based framework and complete set of tools
The healthcare community critically needs a comprehensive and evidence-based approach to improving and sustaining patient Safer Culture. That’s why the University of Texas Health Center, March of Dimes, and Moore Foundation have partnered to develop an evidence-based framework for building Safer Culture, and have created tools to help healthcare organizations measure and improve their cultures.  This framework and its accompanying tools provide a new roadmap for Safer Culture that can ultimately reduce preventable harms.

 

Why we focus on perinatal care

Tragedies such as preventable maternal deaths highlight the urgency for healthcare organizations to adopt cultures of care that promote safety for patients. Our Safer Culture framework is generalizable to all areas of healthcare, but our initial work centers on improving Safer Culture perinatal care because of recent research highlighting serious concerns about perinatal patient safety.

 

In the US between 2000 and 2014, the maternal death rate increased 26.6%, higher than most developed countries. With an average of 700 women dying every year from pregnancy- or childbirth-related causes, it is estimated that 60% are preventable.  In addition, infants suffer high rates of preventable harms in neonatal ICUs. National organizations such as ACOG, AAP, IHI and others are leading specific interventions to improve specific areas of perinatal safety, but for these interventions and others to reach their potential, organizations must improve their overall Safer Culture. Our intention is to provide a roadmap for health care systems, institutions, and providers that enables them to choose a route forward compatible with their existing goals. We also aim to help them sustain a culture that enables all contributors to enact perinatal safety best practices, improving outcomes for both mothers and babies.

 

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