Learning from patient injury claims

Background and aim: The Institute of Medicine report, To err is human, heightened attention to safety and quality performance in healthcare. This has led to demands on healthcare systems to collect data on safety and quality performance. Patient safety improvement requires learning at many levels in the system leading to changes in organizational structure and processes along many dimensions. Safety information systems support learning about the performance of a system by collecting, analyzing, and providing feedback of data. Other industries have come further than healthcare in measuring safety performance as well as in identifying industry specific knowledge about sources of vulnerabilities and hazards. In healthcare, evidence based measures are being developed such as incident reporting systems, medical chart reviews, patient safety indicators and malpractice claims data. The Swedish patient insurance claims database is a source of data on safety performance that has not yet been systematically studied. The aim of this thesis is to assess the potential contribution of patient injury claims have in supporting organizational learning in improving patient safety and to present a framework for the management of patient safety information in healthcare. Principal findings: Patient injury claims are, by themselves, not sufficient to serve as a sensor for vulnerabilities in healthcare. They do, however, provide a broad national source of patient generated information on negative outcomes of care which complements other healthcare generated reporting systems (Study I-II). Swedish healthcare leaders have a relatively high awareness of patient safety and give it high priority. However, few healthcare organizations actively involve patients in improving safety (Study III). Based on the assumption that analogies to known phenomena promote learning, the preservation of genomic integrity was presented as a model to describe different sources of variability, applicable also to