Measures of Patient Safety : Studies of Swedish Reporting Systems and Evaluation of an Intervention Aimed at Improved Patient Safety Culture

Sammanfattning: Unsafe health care delivery results in millions of patients suffering from injuries or death worldwide. A Swedish study estimated the prevalence of preventable adverse events as high as 8.6% in hospital care, which demonstrates that patient safety is no less a problem in Sweden than elsewhere. Reporting of adverse events has become an integral part of patient safety work. The aim of reporting is to identify patient safety problems and provide background data and information for efforts to improve patient safety. However, adverse events in health care can be captured and measured using different methods and stored in disparate systems that are not fully integrated. This makes it difficult to obtain a complete coherent picture of the frequency and nature of various types of adverse events. Another difficulty is to distinguish between adverse events and accepted complications of medical care.The overall aim of this thesis is to generate knowledge for improved understanding of how patient safety can be measured in terms of reporting adverse events and improved by targeting patient safety culture with an intervention implemented in a Swedish county council. Three research questions have been derived from the aim: (1) To what extent can analysis of patient claims contribute to an understanding of the magnitude of the patient safety problem? (2) To what extent do data captured from different reporting systems in Sweden differ? (3) To what extent can a structured intervention that fosters learning on patient safety issues and encourages leadership commitment improve the patient safety culture in a Swedish county council from a five-year perspective?The research is based on studies of three national reporting systems: Lex Maria to the National Board of Health and Welfare; patient claims to the County Councils´ Mutual Insurance Company; and medical data reported to the National Swedish Spine Register (Swespine). Data have also been assembled as part of an evaluation within the Patient Safety Dialogue intervention.This thesis indicates that different Swedish reporting systems provide disparate views and have many discrepancies regarding data quality and coverage of adverse events. Patient claims seem to be an important source of information that can complement information from incident reporting systems and quality registries in health care to provide an understanding of the magnitude of the patient safety problem.The research also shows that a structured intervention that fosters learning on patient safety issues and encourages leadership commitment can improve the culture of patient safety. However, a longer period of time and focused efforts might be required to achieve improvements across all departments within a Swedish county council.