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Transforming health care through research and education.

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Factors Impacting the Implementation, Transfer and Retention of Patient Safety Best Practices in Nor

Whitney Berta, PhD, University of Toronto
G. Ross Baker, PhD, University of Toronto
Jane Banaszak-Holl, PhD, University of Michigan

Understanding an organization’s capacity for change can result in more successful implementation of patient safety best practices.

Hospitals in North America face the task of learning how to make patient care safer.  Regulatory and competitive pressures have focused attention on creating structures and work routines that reduce adverse events.  Hospitals are also recognizing the need to embed new knowledge of patient safety practice in their staff, work routines, information systems and organizational cultures.  In response to these pressures, many organizations have initiated radical change that incorporate evidence-based policies and care practices.  However, while these new patient safety policies and practices are based on well-established research evidence or expert consensus, implementation experiences to date are highly variable across health care organizations.

Why is it difficult for some hospitals and hospital systems to transfer and implement changes that have been successful in other settings?  How do some institutions create a sustainable momentum for safety improvements while others fail?  Research in other sectors of health care and in other industries suggests that a useful pre-cursor to embarking on change is concerted, systematic consideration of an organization’s readiness for change.  Organizations vary in their learning capacity—the rate at which they can identify, import and retain useful knowledge to effect performance improvements.  Because applying new knowledge often requires change, considerations of learning capacity must include considerations of an organization’s capacity for change.

In a study that included an extensive literature review as well as interviews with senior managers from systems that spearheaded progressive patient safety change initiatives, Berta and her colleagues identified seven factors that predict a hospital’s ability to successfully implement radical change in their patient safety practices.

  1. Leadership:  Hospitals that successfully implemented safety improvements had clinical leaders with organizational credibility, linkages with administrators and other clinicians, and familiarity with their organization’s culture.  They actively communicated and demonstrated their commitment to the change initiatives.
  2. Communication:  These hospitals had a common language that was used by all personnel to describe medical errors and events that contributed to them and to alert others to such situations.
  3. Structure:  The hospitals had organizational structures that facilitated intra-organizational information flow relating to the patient safety practice change initiatives.
  4. Culture:  The hospitals had an overall culture that reinforced the desired safe behaviors and changes in patient safety practices.
  5. Resources:  The hospitals provided incentives for their clinical leadership that encouraged and sustained behavior changes related to the change initiatives.
  6. Evaluation:  The hospitals had clear goals regarding the patient safety practice change initiatives and they created mechanisms to assess progress toward those goals.
  7. Process:  Finally, hospitals that successfully implemented patient safety practice changes had a strategy for change that allowed optimal change solutions to emerge from among the changes that were tried.

Based on these factors, the researchers drafted an assessment tool for use by patient safety function staff and senior managers to measure the readiness of a hospital to identify, adopt, replicate and sustain best practices for patient safety.  While further design work is required, the draft tool features a checklist of actions and factors that measure progress in each of the seven areas.  The researchers anticipate that the tool will be helpful in identifying areas in need of action before change is introduced.  Repeated administration of the tool might also serve to gauge progress during the implementation of new patient safety practices and mitigate costly change failures.

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