Trends in safety assurance organizational models and Patient Safety managers (PSms) competences and profile: an empirical analysis in Italian hospitals

Objective: Research aim is to identify new trends in terms of Italian hospital patient safety assurance organizational models and PSMs’ competences and profile. Methods: Analysis has been focused on 54 hospitals in Italian’s Regional Health Boards with a high reputation as far as patient safety is concerned: Emilia-Romagna, Friuli-Venezia-Giulia, Liguria, Lombardia, Piemonte, Toscana, Trento, Veneto. First step, we e-mailed a survey, preceded and followed by a telephone call, to hospital’s sample clinical director to know: (i) patient safety assurance priorities, policy and focus; (ii) patient safety assurance organizational model; (iii) PSMs’ profile, role, and responsibilities; (iv) connection between patient safety assurance and hospital accreditation process. Redemption rate was 24%. Second step, we e-mailed a survey, followed by a telephone call, to the 13 PSMs managers appointed by clinical directors, to know: (i) organizational accountability and power (analysing: job description and responsibilities, main processes affected, main projects or actions or outcomes achieved, tools implemented, resources dedicated); (ii) patient safety staff profile, know-how and competences and educational plans to increase them. Redemption rate was 85%. Sample has a number of beds between 900 and 1500 and staffing between 2400 and 4500, but we had a smaller hospital (200 beds, 650 employees) and a bigger hospital (1700 beds, 5200 employees). Results: Main results on “new trends in term of hospital patient safety assurance organizational models” are: (i) patient safety assurance is always one of the hospital CEO’s achievement and a priority issue within the strategic plan, and the accreditation process has been considered synergic to that; (ii) 38% of hospitals have a “risk management and insurance intermediary”; (iii) patient safety management is always related to: clinical risks, hospital-acquired infections, hazardous materials, electro-medical equipment, building security, hospital fire prevention. There isn’t a department that has responsibilities on all/most of these items because clinical units and technical units share them in different units between different hospitals; (iv) 55% of patient safety management units have a budget; (v) 45% of patient safety management units have full-time staff (min 5 people, max 15). In Emilia-Romagna, Liguria, Piemonte and Veneto, PSMs have interfaces within clinical departments, and in Emilia-Romagna, Veneto and Lombardia, have been helped by a multiprofessional committee; (v) main patient safety management projects are always focused on implementation of: staff education programs on patient safety; adverse events reporting system; clinical risk prevention tools (time out check list, health records audit), empowering patients tools (patient consensus). Main results on “PSMs’ competences and profile in Italian hospitals” are: 73% of PSMs have a medical degree, 9% biology degree, %9 economic degree, 9% hasn’t any degree at all. All the physicians started their career in the ward as professionals. All the other profiles started their career in private industry. On Continuous Professional Development issue, 82% of PSMs attended executive education on patient safety, 36% attended to master’s level on patient safety, but 91% think they need more education on technology assessment and professional and organizational liability. No one has a professional certification, but 27% are ISO auditor. Conclusions: The role of PSMs is still far away from a specific autonomy, especially as far as education and career development are concerned. Therefore, there is room for new professional skills and roles. Because it is across responsibilities, all the healthcare professions need a baseline education on patient safety, and the PSMs need a continuous professional education on technicalities and change management.