My View - Safety is everyone's responsibility

VIEW - Brian Yow, clinical informatics director, digital services, Health NZ

‘A bad system will beat a good person every time’ -Deming -

System safety is about empowering everyone through positive leadership, quality guardrails, appropriate training and clinical governance, underpinned by a culture of excellence and continuous improvement. In a digital era, clinical safety extends to electronic systems that consumers, patients and healthcare workers use every day.

At Health New Zealand | Te Whatu Ora, we have co-developed a Digital Clinical Safety Framework in partnership with consumers, healthcare professionals, technologists and wider health system stakeholders. These concepts are incorporated into our National Clinical Governance Framework.

Digital clinical safety is two-fold. First, it is about ensuring the quality, safety and resilience of digital systems intrinsically. Second, it enables people using these systems to deliver safer, more effective and efficient care extrinsically. Safety-by-design forms a foundational tri-weave alongside privacy and security-by-design.

Our Digital Clinical Safety Principles:

Culture of Safety - We empower our people by weaving a korowai, or cloak of protection, via the fabric of quality and safety systems. Digital solutions are interwoven to enhance safety, clinical safety and digital clinical safety as part of a broader organisational safety culture.

Collaborative Design - Involve healthcare consumers, workforce, technologists and industry throughout the digital solution lifecycle, so that digital health tools are human-centred, fit for purpose, and deliver maximum value and widespread benefits across the ecosystem.

Embedding Equity - Ensure solutions are holistic, inclusive, culturally safe, embrace diversity, and break down barriers through safe use, co-design and evaluation of technology. By embedding equity within our digital health systems, we endeavour to improve equity of access to healthcare services, and ultimately equity of health outcomes for all peoples.

Balanced Decision-Making - Clinical, operational and digital teams play to each other's strengths, amplified via multi-lane cost-benefit assessments, allowing us to make robust and data-informed investment and prioritisation decisions through leadership and clinical governance.

Semantic Interoperability - Promote interoperability among systems. Ensure digital tools and data exchanges are seamless while promoting data sovereignty, data quality, veracity, integrity, security, and privacy.

Continuous Quality Improvement - Build a resilient Safety-II system into our digital health environment by promoting virtuous cycles, striving to make it easier to do the right thing and harder to do the wrong thing. Adapt and improve based on real-world experiences. Review near-misses to bolster resilience, incidents to close gaps, and continuously drive towards “better” by evaluating risks and vulnerabilities.

Embedding into Practice

These principles represent our values and help shape strategy. Frameworks need to be embedded to drive action and influence outcomes. The overarching goal is to bring teams from different backgrounds with different perspectives, skills and expertise closer together. Implementation into practice includes various actions/objectives across strategic, governance and operational levels:

Digital Investment - Digital initiatives, projects and programmes are prioritised using a clinical quality and safety lens.

Clinical Sponsorship - Clinically relevant digital initiatives require sponsorship from relevant clinical leaders at the appropriate level, so that there is senior leadership buy-in, ownership, championing and escalation pathways for clinical governance and risk management.

Clinical Collaboration - Clinically relevant digital initiatives require input from clinicians and consumers at appropriate phases across the delivery lifecycle (especially multidisciplinary, frontline and junior staff).

Hazard Logs - Digital risks can impact clinical care delivery. Hazard logs capture both clinical risks that could arise from digital systems and vice versa. The end of a project is not only the start of business as usual, but also continuous quality improvement. Living hazard logs continue to be co-reviewed at regular intervals by clinical and digital product owners, informing the need for future enhancement via a pragmatic risk-based and cost-benefit approach.

Training - Teams at every level require training according to their needs. Digital specialists with a grounding in health can speak the same language as healthcare workers, and vice versa. Groups cross-pollinate to build a truly integrated clinical-digital team. Likewise, leaders also need to be supported in terms of leadership, governance and evidence-based decision-making.

Standards - Embed relevant clinical safety, quality, data, digital, architecture and interoperability standards into product delivery lifecycles and roadmaps.

Metrics - Clinically relevant digital initiatives should have at least one quality and safety indicator measured as a key success factor, ideally automatically collected as part of monitoring and feedback loops.

Continuous Learning System - Implement an integrated system to capture feedback, incidents, near-misses, risks, mitigations and lessons learnt (and implemented), so that there is whole-of-system visibility, monitoring and assurance via continuous feedback loops. This builds upon Safety II resilience towards Safety III, emphasizing the interconnectedness between people, process and technology across complex adaptive systems, which is further enhanced by incorporating predictive analytics and risk modelling to monitor safety thresholds, especially in the era of AI.

Looking Ahead - Digital clinical safety is a core tenet of clinical governance in digital health. It is a building block for developing sustainable systems and the 10-year Health Digital Investment Plan (HDIP), led by the Centre for Digital Modernisation of Health.

Read more VIEWS

Return to eHealthNews.nz home page