Standardization in Patient Safety: The WHO High 5s Project
Standardization in Patient Safety: The WHO High 5s Project
The High 5s project seeks to determine whether individual hospitals, hospitals within a country, sharing the same health care delivery system, and hospitals in different countries having different languages and cultures are able to implement agreed-upon safety protocols in standardized ways. This requires careful and clear delineation of the protocols and an expectation of hospital adherence to the specified steps in the SOP and uniform application of the evaluation tools.
The High 5s project seeks to optimize the likelihood of success through realization of the following project characteristics:
Whether implementation of SOPs across hospitals within a country or in hospitals in multiple countries is feasible is the first question to be answered by the High 5s project. If the answer to this question is yes, the second question is whether successful implementation of these SOPs results in measurable positive impacts on patient safety that are persuasive. Much new information is being gleaned about the sociopolitical challenges of attempting to standardize care across the boundaries of multiple countries, as well as among hospitals in the same health care system within a country. In essence, this is just the beginning of what can be seen as an exercise in behavior management in quality improvement which asks whether health care workers can adapt their behaviors and environments to standardize care processes in widely varying hospital settings.
Conclusion
The High 5s project seeks to determine whether individual hospitals, hospitals within a country, sharing the same health care delivery system, and hospitals in different countries having different languages and cultures are able to implement agreed-upon safety protocols in standardized ways. This requires careful and clear delineation of the protocols and an expectation of hospital adherence to the specified steps in the SOP and uniform application of the evaluation tools.
The High 5s project seeks to optimize the likelihood of success through realization of the following project characteristics:
Collaboration and good will: the concepts of standardization applied throughout the project have consistently been based on group consensus among the participating countries,
Achievement of country ministerial commitments to the project,
Shared global vision coupled with local ownership,
Provision of an evidence base for all steps in the SOPs and the Impact Evaluation Strategy,
Project design that includes continuous improvement platforms and learning communities, which permit necessary local adaptations that do not change any SOP but modify the way it is implemented in manners acceptable to the hospitals and LTAs in the individual countries, (NB: Hospital or LTA modification of an SOP would violate the principle of standardization and compromise the comparability of data among participating hospitals. However, adaptation to local situations is seen as a necessary part of standardization according to Juran's Quality Control Handbook.),
Acknowledgement that it is appropriate to adapt care to the individual needs of the patient but not to the individual preferences of any provider,
Emphasis on the role of the health care team rather than individuals,
Embodiment of the principles of patient and family-centered care by actively involving the patient and family in the process,
Harnessing shifts in priorities in some countries where better health care value for money expended is now demanded, and patients are becoming more active participants in their own care and
Acknowledgement that health care quality and patient safety issues are increasingly high-profile on national and international agendas.
Whether implementation of SOPs across hospitals within a country or in hospitals in multiple countries is feasible is the first question to be answered by the High 5s project. If the answer to this question is yes, the second question is whether successful implementation of these SOPs results in measurable positive impacts on patient safety that are persuasive. Much new information is being gleaned about the sociopolitical challenges of attempting to standardize care across the boundaries of multiple countries, as well as among hospitals in the same health care system within a country. In essence, this is just the beginning of what can be seen as an exercise in behavior management in quality improvement which asks whether health care workers can adapt their behaviors and environments to standardize care processes in widely varying hospital settings.
