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Key Concepts of Patient Safety in Radiology
Author(s) -
David B. Larson,
Jonathan B. Kruskal,
Karl N. Krecke,
Lane F. Donnelly
Publication year - 2015
Publication title -
radiographics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.866
H-Index - 172
eISSN - 1527-1323
pISSN - 0271-5333
DOI - 10.1148/rg.2015140277
Subject(s) - harm , patient safety , human error , safer , medicine , safety culture , reliability (semiconductor) , accountability , quality (philosophy) , standardization , risk analysis (engineering) , focus (optics) , organizational culture , quality management , root cause analysis , human reliability , health care , management system , operations management , computer science , public relations , computer security , reliability engineering , psychology , social psychology , engineering , philosophy , law , economic growth , optics , operating system , power (physics) , management , epistemology , quantum mechanics , political science , physics , economics
Harm from medical error is a difficult challenge in health care, including radiology. Modern approaches to patient safety have shifted from a focus on individual performance and reaction to errors to development of robust systems and processes that create safety in organizations. Organizations that operate safely in high-risk environments have been termed high-reliability organizations. Such organizations tend to see themselves as being constantly bombarded by errors. Thus, the goal is not to eliminate human error but to develop strategies to prevent, identify, and mitigate errors and their effects before they result in harm. High-level reliability strategies focus on systems and organizational culture; intermediate-level reliability strategies focus on establishment of effective processes; low-level reliability strategies focus on individual performance. Although several classification schemes for human error exist, modern safety researchers caution against overreliance on error investigations to improve safety. Blaming individuals involved in adverse events when they had no intent to cause harm has been shown to undermine organizational safety. Safety researchers have coined the term just culture for the successful balance of individual accountability with accommodation for human fallibility and system deficiencies. Safety is inextricably intertwined with an organization's quality efforts. A quality management system that focuses on standardization, making errors visible, building in quality, and constantly stopping to fix problems results in a safer environment and engages personnel in a way that contributes to a culture of safety.

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