Focus is on the smallest elements of safe patient care because they are defined by standards and  are either present or not-present. 

Both safe and unsafe care can result in good patient outcomes, but it is more likely with safe patient care. Essential to consistently good patient outcomes is safety at all  points of patient care, and in every process, action, and step supporting that point. Here, we refer to the processes, actions, and steps that support care as “elements”. In One Standard, the goal is to improve the outcome, quality, and efficiency of every care process. This is done by making the goal at points of patient care and in the supporting elements to meet safety standards, which makes every violation of the elements of care correctable.

Improving patient outcomes will require changes. One Standard links all change to supporting safety in the elements of care, consistent with healthcare standards. If the focus was on improving poor outcomes, as it usually is, changes might seem random and detached from outcomes for providers. There are correctable elements in some, but not all, cases that result in poor outcomes. Additionally, some cases that result in good outcomes also have correctable elements. Some breaches in healthcare standards are very hazardous and must be corrected even if they have never been associated with a poor outcome at a site, for example reusing needles or syringes. Often, higher surgical volumes are necessary to make evident the results of unsafe care. Here, we focus on two absolute requirements for safety at points of patient care: there must be 1) actions and 2) equipment, medication, and supply preparedness that meet  healthcare standards at every step of patient care . If any of the two requirements are not met, then this is a violation of safe patient care and needs correction.

Unbiased measurements identify goals, areas of correction, and document progress

Elements of safe patient care are absolute and measurable. At this level there is no partial credit -  an element is either present or not present, an action was either done or not done, an item that is required by healthcare standards to be ready and available at a point of care, is either there or not there. Measurements are objective and define the goals for the elements and at points of care. In One Standard, these clearly defined goals  are intended to be understood by everyone  at the beginning of the system strengthening process. It does not allow for goals to be debated before being adopted, and thus improvements are not delayed. In One Standard, there are measurements of action and preparedness elements at points of care, which are grouped into categories. Preparedness categories include anesthetic monitoring equipment, adult airway equipment, medication in the operating room, and pediatric monitoring equipment in the PACU. The elements in each categories that meet safety standards are counted, then divided by the total number of elements in that category. A percent score is thereby calculated, which shows the category’s compliance with standards and represent safe patient care. The percent score places everyone at the same starting point, allows trends to be followed and improvements to be verified. This score can also be used to compare safe patient care across a system, a country, or globally.

Financial Considerations In Healthcare

Money is a focus in One Standard because failing to do this is suicide. Hospital and hospital systems that do not produce a cost-effective product are doomed to the same fate as the faith-based hospitals in the USA during the 20th century, survival in name only, or worse. Hospitals must offer quality, cost-effective services to survive. Hospitals that are out of touch with cost, spend wastefully, have systems that support shrinkage, are not efficient, not standardized, and more, may continue for a while, but this is not consistent with successful businesses. In the Roadmap, per design axioms, corrective changes include standardizing processes to avoid duplications of services and omissions, thus increasing efficiency and cost-efficient purchases. Both support a cost-effective healthcare product.

Costs and money are a long-muted subject but here it is an almost deafening sound planted in the design axioms of purchases and corrective changes. For this reason, some targets in profit centers are given higher priority on the master target list. Money is a limited resource, and per design axioms, equipment, general, and capital purchases must be cost-effective. There are One Standard and other tools that show how to apply these concepts to practice.

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