Standardization and Improvement of Patient Safety: Lessons from The WHO High 5s Project

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Nowadays, ensuring patient safety has become one of the most acute issues in general, considering the complex, chaotic, and fast-changing environment of modern healthcare. With increasing rates of medical errors and adverse events, the need for strategies to reduce risk and increase the opportunity for optimal outcomes has become sorely apparent. The most important ways to meet these challenges are by standardizing healthcare processes. The World Health Organization, having realized this fact, launched the High 5s project as an international patient safety initiative for developing, implementing, and assessing standardized operating protocols in various healthcare environments. Two pertinent questions arose, and the answers to them were the main objectives of this initiative: Is it possible to have standardized healthcare processes implemented in multiple countries and hospitals? If so, what would it mean for patient safety? The role standardization plays in patient safety is explained through the lessons learned while implementing the WHO High 5s project, which is the application of standardized practices in large and sustainable ways that have ushered in improvement in the delivery of healthcare.

Understanding the Need for Standardization in Health Care

The very nature of the healthcare environment is that it is complex. That would mean a number of processes and actors are dependent on each other. This frequently paves the way for variations in the delivery of care, which furthers the chance of potential errors and incidents. In this regard, standardization can be described as the development and implementation of consistent procedures and guidelines to maintain equality in health delivery across different areas. The very principle of standards lies in the fact that, while brought down to a minimum, variability in processes becomes a more likely chance to avoid error and, therefore, provides for patient safety.

One of the underlying challenges in health care is the tremendous variability in clinical practices across health care providers and/or among health care recipients with the same conditions. Various directions taken by different health care providers are dependent on their training, experience, and what is in place. Variability usually leads to different results for patients in that, in one case, a patient can receive a very good standard of care, while in another, this might not be the case. Standardization should, on the other side, be approached to wipe out that inconsistency and to assure that all patients receive care according to the best evidence and best practices.

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The WHO High 5s Project: An International Endeavor

The WHO High 5s project, launched in 2006, focused on enhancing some of the most compromising patient safety concerns by formulating and applying standardized operating procedures. The countries that participated in the project, as well as their participating hospitals, both set out to follow the standard protocols therein as the first level in ensuring safer care. They targeted such crucial aspects as correct surgery, medication reconciliation, as well as the use of concentrated injectable medicines. Thus, the selection of these areas was due to them being the common originators of preventable harm in healthcare settings.

One key area of innovation of the High 5s project was the fact that it was global in scope. Engaging hospitals in different countries provided the opportunity to test the feasibility of standardized protocols across diverse healthcare systems. In other words, such a global approach worked to determine whether the influence of cultural, organizational, and systemic factors on adoption and effectiveness and, hence, impacting viability ultra depended on the feasibility of implementing standardized protocols across diverse healthcare systems.

Implementing Standardized Protocols: Challenges and Successes

The experience of making a reality out of standardizing protocols in the High 5s project demonstrates several important lessons on problems and successes in standardization in healthcare. One of the biggest challenges in making that possible was ensuring the compliance of the SOPs across hospitals and different countries. Oftentimes, the routine and underlying doctrines of caring for patients at a health provider are deeply entrenched and hard to change. Moreover, the differences that exist in health infrastructure, resources, and training among various countries in the world are relatively huge potential challenges to the universal adoption of SOPs.

However, based on this project, it was proven that standardization is still possible and was deemed to have positive returns as well. Hospitals that were able to fully conduct the developed SOPs reported improvements in patient safety. For example, despite the drop in surgical cases, the implementation of ‘correct surgery’ led to the decrease in surgical errors, and the same was observed for medication reconciliation. These successes reveal that standardized conditions can reduce variability within the practice process towards positive patient results.

Patient Safety

The multi-faceted impact of standardization on patient safety includes one of the most important benefits: reduced preventable harm. By ensuring all healthcare providers follow the same protocols, the likelihood of errors is decreased. This would be important in high-risk areas like surgery and the administration of medication; even the slightest errors can produce terrible outcomes.

By improving healthcare systems’ reliability: Every step made towards a standardized system is well described and adequately monitored, therefore reducing the chances of errors to be overseen. The reliability that is crucial in this case is related to the care guaranteed to patients. It assures the patients that they can receive even grades of high care regardless of where they end up being treated.

Another critical impact of standardization is the improvement of communication between the healthcare providers. Standard protocols offer a language and framework for care delivery, and health care providers find it easier coming together as a team, not leaving out anything in care provision for a patient. This becomes more important, especially in the complex areas of care where many providers are offering care.

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Lessons Learned from the WHO High 5s Project

The WHO High 5s project is very applicable to policymakers and care providers in a basic lesson for promoting patient safety through standardization: leadership and commitment at every level of the healthcare system. The project High 5s reiterated this with leadership and commitment from both clinical and administrative leaders in driving and ensuring the availability of resources and intense training appropriate for the implementation of standardized protocols.

Secondly, there is the lesson of the need for flexibility within the standardization process. It would actually be their desire to see a reduction in diversity, but there should be some acknowledged level of modification of the standard protocols for different settings in the healthcare delivery system. The High 5s project has shown that, in order for standardization to become effective, there must exist some equilibrium between strict compliance with the protocols and the ability to adapt them to the local conditions.

Third, the project will insist that monitoring and evaluation take place during the process of standardization through time. Putting in place standard protocol is not a single activity but a process that involves continuous measurement to establish whether the protocol accurately followed is proper and capable of specifications. Principal measures in the High 5s project were its assessment with an all-inclusive approach that mixed up process measures, including SOP compliance, but also outcome measures, which included decreases in the occurrences of AEs. This sort of comprehensive technique in measuring performance was critical in the assessment of areas that would require improvements so as to guarantee successful implementation of standardization for the long term.

The Future of Standardization in Health Care

Lessons learned in the WHO High 5s project bear a record of what should be the way forward in standardization in healthcare. Health care systems are progressively developed, with incremented needs for standardized practice; however, the success of such a vision will depend on how the health care providers and policymakers will take up the gauntlet thrown at them by the High 5s project.

There are significant potential future development areas in the integration of other patient safety initiatives. For example, the aspects of standardization could be aligned with the communication initiatives of healthcare providers, patient engagement, and the use of health information technology. Comprehensive understanding of patient safety enables the healthcare system to derive the maximum benefit from standardization and, hence, more improvement in the patients’ outcomes.

Another important area of future research is the extent to which standardization can be tailored within the needs of various patient populations. The High 5s project showed that standardization can work in very diverse health care settings, but many areas remain where the practices would need further study to understand how they might be adapted to serve the specific needs of elderly patients, those with chronic conditions, and other special groups.

Conclusion

The WHO High 5s project showed that standardization can be a powerful tool toward this increase in patient safety. Standardized protocols in health can eliminate or reduce errors, make healthcare systems more reliable, and avoid problems in management as well as care delivery. All in all, the success of the standardization efforts depends on strong leadership, flexibility, and continuous monitoring. Lessons from the High 5s project will be extremely useful in the guidance of any future efforts to standardize and improve patient safety, especially when seen in the light of new challenges that health systems are confronted with.

References

  1. Lim, J.H., Ahn, J.W. and Son, Y.J., 2019. Association between hospital nurses’ perception of patient safety management and standard precaution adherence: A cross-sectional study. International journal of environmental research and public health, 16(23), p.4744.
  2. Gurková, E., Zeleníková, R., Friganovic, A., Uchmanowicz, I., Jarošová, D., Papastavrou, E. and Žiaková, K., 2020. Hospital safety climate from nurses’ perspective in four European countries. International nursing review, 67(2), pp.208-217.
  3. Lee, T.Y., Sun, G.T., Kou, L.T. and Yeh, M.L., 2017. The use of information technology to enhance patient safety and nursing efficiency. Technology and Health Care, 25(5), pp.917-928.
  4. Vincent, C., Burnett, S. and Carthey, J., 2014. Safety measurement and monitoring in healthcare: a framework to guide clinical teams and healthcare organisations in maintaining safety. BMJ quality & safety, 23(8), pp.670-677.
  5. Leotsakos, A., Zheng, H., Croteau, R., Loeb, J.M., Sherman, H., Hoffman, C., Morganstein, L., O’leary, D., Bruneau, C., Lee, P. and Duguid, M., 2014. Standardization in patient safety: the WHO High 5s project. International journal for quality in health care, 26(2), pp.109-116.
  6. Van Beuzekom, M., Boer, F., Akerboom, S. and Hudson, P., 2010. Patient safety: latent risk factors. British journal of anaesthesia, 105(1), pp.52-59.
  7. Henneman, E.A., 2017. Recognizing the ordinary as extraordinary: insight into the “way we work” to improve patient safety outcomes. American Journal of Critical Care, 26(4), pp.272-277.

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