Patient Safety and Quality

Examining processes, not outcomes, improves patient safety in hospitals

When adverse events occur, hospitals typically use two approaches, or a combination of the two, to document them. The outcome approach examines the harm a patient suffered, such as a heart attack that may or may not have been a result of medical care. The process approach looks at the steps leading up to the event to see how systems can be improved to prevent future errors, such as giving a patient the wrong medication. A new study from RAND researchers determines that the process approach is superior to the outcome approach for improving patient safety, because process reports typically offer more useful information on factors that caused adverse events and promote a blame-free culture for voluntary reporting.

Of the 3,875 incident reports from two Southern California hospitals, half focused on care process variations, 35.3 percent on undesirable outcomes, and 10.3 percent on a mix of both. Nearly all the process-oriented reports pinpointed how incidents could have been prevented, but 75 percent of the outcome-oriented reports did not offer that information. The authors suggest that neither process- nor outcome-oriented reports are perfect instruments. Process-oriented reports need more particulars to be useful. One way to gather richer details is by using an electronic reporting system that offers a classification system for patient safety events and encourages providers to provide in-depth descriptions that may reveal factors that contributed to the incident.

Although outcome-oriented reports do not specify if an adverse event occurred and don't offer information on preventing them, hospitals can still use the information to conduct thorough investigations when necessary. This study was funded in part by the Agency for Healthcare Research and Quality (HS11512). See "Comparing process- and outcome-oriented approaches to voluntary incident reporting in two hospitals," by Teryl K. Nuckols, M.D., M.S.H.S., Douglas S. Bell, M.D., Ph.D., Susan M. Paddock, Ph.D., and Lee H. Hilborne, M.D., M.P.H., in the March 2009 Joint Commission Journal on Quality and Patient Safety 35(3), pp. 139-145.

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