Environmental Scan Of Patient Safety Education And .
Contract Final ReportEnvironmental Scan of Patient SafetyEducation and Training ProgramsPrepared for:Agency for Healthcare Research and QualityU.S. Department of Health and Human Services540 Gaither RoadRockville, MD 20850www.ahrq.govContract No. 290200600019Prepared by:American Institutes for ResearchWashington, DCAHRQ Publication No. 13-0051-EFJune 2013
This document is in the public domain and may be used and reprinted without permission.Suggested citation:Environmental Scan of Patient Safety Education and Training Programs. (Prepared by AmericanInstitutes for Research, under contract HHSA290200600019i). AHRQ Publication No. 13-0051EF. Rockville, MD: Agency for Healthcare Research and Quality; June 2013.None of the investigators has any affiliations or financial involvement that conflicts with thematerial presented in this report.This report was funded by the Agency for Healthcare Research and Quality (AHRQ), U.S.Department of Health and Human Services, through contract HHSA290200600019i to theAmerican Institutes for Research. The opinions expressed in this document are those of theauthors and do not reflect the official position of AHRQ or the U.S Department of Health andHuman Services.
ContentsIntroduction .1Chapter 1. Environmental Scan .Define Patient Safety .Identify Sources of Information .Determine Inclusion Results of Environmental Scan Track Results 334677Chapter 2. Electronic Searchable Catalog . 9Standardized Taxonomy . 9Standardized Database Template for Data Abstraction 12Database Development . 15Results from Data Abstraction . 18Chapter 3. Qualitative Analysis of Consumer Perspectives . 25Description . 25Themes from the Qualitative Analysis 26Chapter 4. Results and Next Steps . 27Summary of Themes 27Next Steps 28References . 29AppendixesAppendix A. Key Search Terms for Environmental Scan 31Appendix B. Data Entry Screens . 37Appendix C. Query Screen . 51Appendix D. Sample Query Results . 55Appendix E. Frequency Analyses for Content Area and Clinical Area 57
IntroductionAs the leader in patient safety education, the Agency for Healthcare Research and Quality(AHRQ) must ensure that its efforts to improve patient safety not only reflect the state of the art,but also account for the most current, evidence-based practice. At the conclusion of the PatientSafety Improvement Corps (PSIC) program in 2008, AHRQ realized the need to adapt futureefforts (whether via another iteration of PSIC or another delivery model) to ensurecomprehensive and accurate coverage of the current patient safety education domain. In 2009,AHRQ’s Center for Quality Improvement and Patient Safety (CQuIPS) identified a need toconduct an environmental scan of existing patient safety education and training programs withthe ultimate goal of building a searchable database for the general public. A contract wasawarded to the American Institutes for Research (AIR) to support AHRQ in this effort.The project consisted of the following core tasks to meet the stated objectives (as illustrated inExhibit 1): Collect data on and catalog the universe of current, active, and recurring patientsafety education and training programs. Characterize these programs by salient factors (e.g., sponsor, targeted/eligibleaudience, program objectives, delivery method, duration, content, cost). Provide an easy-to-use, searchable database of the catalog that can be used internallyby AHRQ and may be imported into the AHRQ Patient Safety Network (PSNet),without modification, for access by users of that site. Provide analysis, conclusions, and recommendations based on observations/findingsand potential future patient safety education and training that may be supported byAHRQ.Exhibit 1. Primary Tasks for Conducting an Environmental Scan of Patient SafetyEducation/Training ProgramsCollect Dataand msProvideAnalysis andConclusionsThroughout the contract period, AIR prepared several reports documenting the methodologicalplan and data collection procedures employed during each phase of the project. Thesedeliverables include the following: Methodology and Inclusion/Exclusion Criteria,1 which presented the methodologicalplan for conducting the environmental scan and specified the criteria used to1
determine whether programs identified through the scan process would be included inthe final catalog. Standard Taxonomy for the Environmental Scan,2 which detailed the framework offeatures used to categorize patient safety education and training programs thatultimately serves as the basis for the catalog search engine. Standard Template for Data Abstraction,3 which detailed the data fields used forabstracting information about programs identified during the environmental scanphase of this project. Qualitative Analysis of Consumer Perspectives of Patient Safety Education andTraining Programs,4 which reported the results of an informal exploration ofconsumer perspectives on the advantages and disadvantages of differentcharacteristics of patient safety education and training programs.This report highlights information presented in the previous deliverables, details the final resultsof the environmental scan and data abstraction phases, and describes the features of thesearchable catalog. The report is divided into the following chapters: Environmental Scan.Electronic Searchable Catalog.Qualitative Analysis of Consumer Perspectives.Results and Next Steps.2
Chapter 1. Environmental ScanThe environmental scan, as proposed in the deliverable, Methodology and Inclusion/ExclusionCriteria,1 served as the foundation for the electronic searchable catalog and, as such, required aninclusive and methodologically rigorous approach. During the environmental scan, AIRidentified patient safety programs, using publicly available sources. The purpose of this step wasto identify a comprehensive set of programs that met predetermined inclusion criteria and collectsimilar information about each of the programs to enable a standardized presentation in anelectronic catalog. The environmental scan consisted of the following four primary steps: Define patient safety.Identify sources of information.Determine inclusion.Track results.Define Patient SafetyAs a preliminary step in the refinement of the environmental scan methodology, we conducted aliterature review to identify various definitions of patient safety from reputable sources,including books, scholarly journals, Federal Government agency reports, and organizationalresources. Exhibit 2 provides the most relevant definitions with their associated references.Exhibit 2. Relevant Definitions of Patient SafetyDefinition of Patient SafetyReferenceFreedom from accidental or preventable injuriesproduced by medical care.Agency for Healthcare Research and Quality (AHRQ,via http://www.psnet.ahrq.gov/glossary.aspx)The prevention of health care errors andelimination or mitigation of patient injury causedby health care errors.National Patient Safety FoundationFreedom from accidental injury; ensuring patientsafety involves the establishment of operationalsystems and processes that minimize thelikelihood of errors and maximize the likelihood ofintercepting errors when they occur.Kohn LT, Corrigan JM, Donaldson MS. To err ishuman: building a safer health system. Advancecopy. Washington, DC: National Academy Press.1999. # 0-309-06837-1.The avoidance, prevention, and amelioration ofadverse outcomes or injuries stemming from theprocesses of health care. These events include"errors," "deviations," and "accidents.” Safetyemerges from the interaction of the componentsof the system; it does not reside in a person,device, or department. Improving safety dependson learning how safety emerges from theinteractions of the components. Patient safety isa subset of health care quality.Cooper JB, Gaba DM, Liang B, et al. National PatientSafety Foundation agenda for research anddevelopment in patient safety. Medscape Gen Med.2000; 2: [14 p.].3
Definition of Patient SafetyActions undertaken by individuals andorganizations to protect health care recipientsfrom being harmed by the effects of health careservices.ReferenceSpath PL. Patient safety improvement guidebook.Forest Grove, OR: Brown-Spath & Associates. 2000.# 1-929955-07-3.The prevention of harm to patients. Patient safetyefforts aim to reduce errors of commission oromission.Disease Management Association of America(DMAA, viahttp://www.psqh.com/marapr05/disease.html)Based upon our findings and the primary objectives of this effort, we developed a metadefinition of patient safety, combining the most meaningful components of the availabledefinitions. Through coordination with AHRQ project officers, AIR refined this meta-definitionto establish the final definition below:Patient safety is the prevention and amelioration of adverse outcomes or injuriesstemming from the process of health care, as well as initiatives aimed towardsimproving patient safety processes and outcomes.This definition of patient safety was used to steer all scanning activities and serves as the primarybasis for inclusion in the catalog.Identify Sources of InformationWe targeted two types of information sources during the environmental scan process: (1) peerreviewed literature; and (2) Internet and grey literature for prior, new, and existing patient safetyefforts. The literature search began with defining a set of uniform keyword search terms (seeAppendix A for a list of the terms used during this search).Peer-Reviewed LiteratureUsing the list of keyword terms, the team searched medical and social science peer-reviewedliterature, including both descriptive qualitative and quantitative studies, using PubMed,PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and otherdatabases, as shown in Exhibit 3. In addition, we scanned conference programs for relevantproceedings, such as the Institute for Healthcare Improvement and the National Patient SafetyFoundation national meetings. The scope of the search was limited to patient safety educationand training resources developed domestically and focusing, in whole or large part, on criticalpatient safety topics and issues. The searches were limited to English-language articles withabstracts published since 1999.4
Exhibit 3. Databases to be Used in the Environmental ScanDatabases for ScanningPsycInfoPubMedCINAHLMEDLINEHealth BusinessMedlinePlusHealth Services Research Projects in Progress(HSRProj)National Library of Medicine (NLM) GatewayPublic Affairs Information Service (PAIS)InternationalDissertation AbstractThe peer-reviewed literature search yielded critical information about best practices forevaluating and implementing patient safety education and training. When reviewing journalarticles, we identified a program anonymity trend. That is, the peer-reviewed literature tended tofocus on different approaches to patient safety education and training or evaluation of programs;rarely, however, did this body of literature name actual programs. In many cases, we extendedour searches by seeking information about the authors and developing additional search terms forthe environmental scan. For this reason, the main focus of the environmental scan was on theInternet and grey literature.Internet and Grey LiteratureAs with peer-reviewed literature, we used the pre-identified set of uniform keyword search termsthat were keyed in a variety of search engines listed inExhibit 4 to search the Internet.Exhibit 4. Search Engines Used in the Environmental ScanSearch Engines for ScanningGoogleSearch MedicaYahoo! uilWe began the search by scanning Web-based sources to identify prior patient safety educationefforts that might serve as a foundation for current initiatives (e.g., Health Resources andServices Administration-funded research initiatives). Additionally, we identified grey literature,unpublished literature, and Internet sources that describe current and existing education andtraining programs.To scan the grey literature, we explored the results from a variety of search engines, includingGoogle, Yahoo, Bing, and others to ensure that some challenges associated with Internet5
searches (e.g., search engine optimization and differing search algorithms) were accounted for asmuch as possible. It quickly became clear that some search engines only provided aggregatedresults from the more popular search engines (i.e., Google and Bing). For this reason, we limitedthe environmental scan to Google and Bing. It should be noted that although Google and Bingresults yielded a high degree of overlap, we used both search engines to ensure no programswere missed.Determine InclusionOnce a program was identified, we then applied a set of inclusion criteria to ensure only relevantprograms would be fully abstracted and documented in the final catalog. AIR, in collaborationwith AHRQ, identified the following inclusion criteria. Is the core content of the training program truly patient safety oriented? Giventhe purpose of this project, all programs to be included in the catalog must have apatient safety orientation. This criterion was intended to eliminate programs that didnot fall within the patient safety spectrum, such as Customer Focus Inc.’s PatientSatisfaction Skills Training Program, which focused primarily on improving patientsatisfaction and Hospital Consumer Assessment of Healthcare Providers and Systems(HCAHPS) scores. Inclusion was determined using the meta-definition of patientsafety provided earlier in this chapter. Is the program based on core instructional objectives? A good educational ortraining program should be founded on a set of core instructional objectives.Objectives can be learning, program-based, or skill-oriented and do not necessarilyhave to be measured or assessed. A program that does not specify any instructionalobjectives may be an indicator of a less structured program. An example of a programthat was excluded from the catalog is the Putting Humor to Work to Improve PatientOutcomes training program offered by Creative Training Solutions because noexplicit instructional objectives were provided. Is the target audience health care professionals, patients and families, or anotherstakeholder group? The program should have a clearly defined target audience. Thisrequirement is less strict than the others, but in essence, we wanted to ensure thatincluded programs addressed a specific health care-related target audience or multiplehealth care-related audiences. This criterion was intended to eliminate programs thatdo not have a clearly defined health care target audience, such as the NationalAssociation of Safety Professionals’ Safety Manager/Training Certification Course,which does not focus on health care professionals or any of the health carestakeholder groups, but rather on safety managers in general. Is the education or training program currently being offered in the UnitedStates? The program must be offered or publicly available in the United States. As ageneral rule, programs more than 5 years old were excluded, as were programs notcurrently offered or available in the United States, to ensure that the resulting catalogprovides information about programs available for current use by stakeholder groups.Included programs could be dormant (with no active training occurring, but could bearranged), and the source material did not have to be U.S.-based, the program just hadto be available for implementation within the United States. An example of a program6
that was not included is the Universitair Medisch Centrum (UMC) Utrecht PatientSafety Training Program in the Netherlands, which was a 2-day course offered in2006 but only available and accessible to medical residents at UMC Utrecht. Is the training program designed for another industry and merely applied toquality improvement and patient safety? Finally, the program must not have beensimply applied to the health care setting but must have been specifically tailored forthis setting. Training programs designed for another industry that can be applied toquality improvement and patient safety were only included if efforts were made toadapt the program to the needs and characteristics of the health care setting. Theintent was to eliminate a broad spectrum of programs that could, in theory, be appliedto health care but that have not been contextualized or adapted in any way, such asDuPont/Coastal’s PeopleSafety Training, which has not been tailored specifically tothe health care setting.To ensure the above criteria were applied properly, researchers conducted a pilot test using fivepatient safety training programs. Researchers individually applied the criteria for five identifiedprograms. Once this exercise was completed, the researchers discussed the application of thecriteria and assessed the extent of inter-rater agreement. To ensure that the inclusion criteriawould be applied consistently, AIR conducted a frame-of-reference training with all researchersto ensure a shared mental model of appropriate criteria application. In cases where a researcherhad questions about the application of the inclusion criteria, a second researcher was asked toevaluate and discuss the inclusion criteria with respect to the particular program. In cases whereconsensus among researchers could not be reached, a third researcher (the Project Director orPrincipal Investigator) was asked to assess whether the program merited inclusion. Additionally,scanners held weekly meetings to discuss difficulty with scanning and ensure proper applicationof inclusion criteria.Results of Environmental ScanThe environmental scan yielded a total of 821 potential patient safety programs. The team tendedto err on the side of inclusion for programs with limited information available at the time of thescan because each program would be reviewed more thoroughly during data abstraction.Track ResultsAIR developed a Microsoft Excel worksheet to document possible patient safety education andtraining. Information was documented on the keyword used, the database/search engine used, theprogram sponsor, the program name, the Web address of the potential education/trainingopportunity, the link in which the program was originally identified, and a preliminaryevaluation of the program against the identified inclusion criteria, as described in the nextsection.7
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Chapter 2. Electronic Searchable CatalogIn this chapter, we detail the development of a standardized taxonomy, which served as the basisfor the query tool in the searchable database of patient safety education and training programs,the development of the template for abstracting information about included programs, and finallythe searchable catalog itself. For the full reports, please refer to the previous deliverables,Standardized Taxonomy for Environmental Scan2 and Standardized Template for DataAbstraction.3Standardized TaxonomyInitially, AIR developed a taxonomy of features to categorize patient safety education andtraining programs. The taxonomy was designed to serve as the platform for the search engine forthe resulting catalog. We began by conducting a thorough review of the programs stemmingfrom the environmental scan phase of this project with the aim of yielding a list of the mostcommon, salient characteristics of these patient safety education and training programs. N
This report highlights information presented in the previous deliverables, details the final results of the environmental scan and data abstraction phases, and describes the features of the searchable catalog. The report is divided into the following chapters: Environmental Scan. Electronic Searchable Catalog.
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may be substantially higher (James, 2013, JPS) Crossing the Quality Chasm: A New Health System . National Patient Safety Goals IHI’s 100K lives Campaign 2004 2005 Patient Safety . Patient Quality & Safety Movement: Worldwide 2000 An Organization with a Memory NHS forms National Patient Safety Agency 2001 NPSF’s launches Patient Safety .
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