Prospective Hazard Analysis

Research Theme: Healthcare Design

Despite the vast majority of care being excellent, medical errors in the UK result in harm to nearly one million patients each year. In response, the UK's National Health Service (NHS) continues to develop its ability to investigate incidents after they have occurred. Whilst this is essential, little has been done to explore how using Prospective Hazard Analysis methods could prevent these incidents before they occur. This project investigates the usability and utility of these methods.

This project has a dedicated website which may be accessed here.

Motivation

Retrospective Hazard Analysis methods such as Root Cause Analysis and Significant Event Audit have been introduced recently into the NHS. Prospective Hazard Analysis (PHA) methods, however, can be used to prevent incidents in the first place. Their adoption in the NHS could significantly enhance the safety and quality of patient care.

Objectives

  • Identify potentially suitable PHA methods for use in the NHS.
  • Evaluate the ease of use and capability of PHA methods to uncover hidden high-risk areas.
  • Develop a toolkit to help NHS staff to identify and use the right PHA method in the right situation.

Method

Interviews and literature reviews are being used to identify potentially suitable PHA methods. Interviews will be undertaken with healthcare practitioners, to understand their needs. Once a shortlist of PHA methods is developed, these will be evaluated experimentally with NHS practitioners.

Findings

This project is in its earliest stages. However, it is likely that any PHA methods will need to be intuitive, time-efficient and powerful if they are to be welcomed into the NHS, given the great time pressure that its staff are already under. Working with the NHS, to understand what methods are reasonable, is therefore essential.

The USA appears to be adopting "Healthcare Failure Modes and Effects Analysis" as a stock PHA method. However, this has been found to be very time-consuming (Van Tilburg et al., 2005).

Details

The project will be divided into several stages. Stage 1 will pilot two case studies in two different settings in the NHS; Primary care (a GP surgery) and secondary care (a hospital). These studies will investigate the usability and utility of at least two PHA methods.

At the same time, work will be undergoing to identify further case studies for Stage 2, where many more PHA methods and case studies will be evaluated. During this stage, a "toolbox" of PHA methods will be developed. The toolbox will explain how to use each PHA method that is deemed potentially suitable for use in the NHS, and will help the user to select the most appropriate method (or methods) for the particular situation in healthcare for analysis.

Stage 3 will involve evaluating and modifying the toolbox; after which PHA will be introduced into the NHS.

Acknowledgements

We would like to thank the Department of Health for its funding, and the invaluable contributions of NHS staff in assisting with this project.

Selected Publications

  • Van Tilburg, C.M., Leistikow, I.P., Rademaker, C.M., Bierings, M.B. and van Dijk, A.T. (2006), "Health Care Failure Mode and Effect Analysis: a useful proactive risk analysis in a pediatric oncology ward", Qual Saf Health Care, 15(1), pp. 58-63.
  • Linkin, D.R., Sausman, C., Santos, L., Lyons, C., Fox, C., Aumiller, L., Esterhai, J., Pittman, B. and Lautenbach, E. (2005), "Applicability of Healthcare Failure Mode and Effects Analysis to healthcare epidemiology: evaluation of the sterilization and use of surgical instruments", Clin Infect Dis, 41(7), pp. 1014-9.