Roadmap for patient safety research: approaches and roadforks.
Patient safety improvement is a healthcare priority worldwide. Pioneer research reports include the 1984 Harvard Medical Practice Study, and the 1999 report "To err is human''. Patient safety research is expanding rapidly. Among the Scandinavian countries, Denmark is the patient safety improvement leader, and Norway is the laggard, having only recently institutionalized safety research and then having started with industrial safety research, and only recently having expanded into patient safety research.


OBJECTIVE
To produce a roadmap for patient safety research, indicating three main roadforks. Patient safety research can be conducted along a number of lines. To identify patient safety problems and come up with ideas for patient safety improvement one can investigate 1) particular cases of adverse events, 2) the design of healthcare delivery systems, or 3) the culture of the care-giving institutions. The study of safety culture can be subdivided into the study of organization culture in general (and in particular of leadership culture) and the study of patient safety culture. The article provides a number of references to existing instruments of patient safety research.


METHODS
Qualitative interpretation of the referenced literature.


RESULTS
Scrutinizing adverse events for errors is health care's traditional way of improving patient safety. The idea of rethinking the design of care delivery systems has been accompanied by claims of modernity. The study of patient safety culture is the most recent approach. The three approaches are discussed in separate sub-chapters.


CONCLUSIONS
Although chronology suggests a developmental trend, the three approaches should not necessarily be seen as steps up the ladder of evolution. Each approach does have its merits.
Hofoss
Dag
D
Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway. dag.hofoss@ahus.no
Deilkås
Ellen
E
D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D015279:Organizational Culture; D011785:Quality Assurance, Health Care / Q000379:methods; D012106:Research; D017751:Safety Management / Q000379:methods; D011795:Surveys and Questionnaires