Novel Use of Hazard Ratings from Safety Engineering to Target Error Reductions in Primary Care

Presenter: Gurdev Singh, PhD

Institution: Department of Family Medicine, SUNY at Buffalo, New York

Co-Author: Ranjit Singh, MD, MBA

Introduction: Primary Care is a highly complex environment in which multiple safety problems have be identified.

Each primary care practice can be viewed as a complex adaptive system with its own unique characteristics. To make progress in improving safety with limited resources, each practice needs to identify those safety problems that pose greatest risk to their patients and focus efforts on these.

Objective: To develop and test a novel approach to prioritizing safety problems based on the concept of Hazard adapted from safety engineering. This permits prioritization based on the combination of error frequency and severity of consequences.

Methods: A survey instrument is used to elicit staff perceptions of frequency and severity of multiple different primary care errors. For each error, a Hazard score is calculated based on the product of frequency and severity. To achieve this, the qualitative responses are first converted to quantitative values using an algorithm that takes into account the risk aversive attitude of patients and staff. The Hazard scores thus derived are used as the basis to prioritize safety problems.Setting/ Participants: Two rural primary care group practices with 15 and 27 staff respectively.

Main Outcome Measures: Identification of top-priority errors based on highest Hazard scores. Comparison is made between priorities identified by physicians versus nursing versus administrative staff within each practice.

Results: Each site identified its own set of priorities with very little overlap. Within each site there was high concordance between priorities identified by physicians, nursing and administrative staff. Priorities also remained stable with variation in the degree of risk aversiveness assumed in the Hazard calculation.

Discussion: The Hazard concept from safety engineering can be used to identify, based on staff perceptions, the most dangerous safety problems for each practice. Concordance between groups within each practice attests to the validity of the approach.