**2. Methodical paradigm**

Threats to patient safety result from complex causes. Improvements for safety are possible with analysis of causes of error. With this knowledge we need to design '*Preventive systems of care'* so as to make errors less common and less harmful when they do occur" [4].

The steps for practice of preventive Medicine in Hospitals should be

i.Intervention design: Defining and designing the content and the implementation plan of the intervention

*Prevention Strategies for Patient Safety in Hospitals: Methodical Paradigm, Managerial… DOI: http://dx.doi.org/10.5772/intechopen.106836*

ii.Intervention implementation

iii.Intervention institutionalization

#### **2.1 Defining the problem**

Critical steps toward improving the safety of the health care system include ensuring that the system is aware of what errors can occur and thus leading to formulation of effective remedies – Preventive action plan.

Internationally, an important study in this regard has been *The Harvard Medical Practice Study.* This was an interdisciplinary study of medical injury and malpractice, and was conducted in the early 1990s [5].

The first part of this study focused on the incidence of adverse events, defined as injuries resulting from negligent or substandard care. *Brennan et al.* reported that adverse events occurred in 3.7 percent of the hospitalizations (95% confidence interval [CI] = 3.2–4.2). Also, they reported that 27.6 percent (95% CI = 22.5–32.6) of the adverse events were due to negligence. Further, 13.6 percent of the adverse events led to the death of the patient [5].

The second part of the Harvard Medical Practice Study analyzed the records of 1,133 patients who had disabling injuries caused by medical treatment. *Brennan et al.* reported that among these patients, drug complications were the most common type of adverse event (19 percent), followed by wound infections (14 percent) and technical complications (13 percent) [6].

The latest figures are still disturbing. Patient harm due to adverse events is one of the top 10 causes of death and disability in the world [7].

#### **2.2 Prevention strategies: concepts**

Modern health care is highly complex, high risk, and error prone. All this makes, not surprisingly, health care errors and consequent adverse events a leading cause of death and injury. Well-documented methods to prevent the occurrence of many of these errors need to be constantly evolved. Safe Practices reducing the risk of harm resulting from the processes, systems, or environments of care are required. Patient safety should be the highest priority for health care providers [8].

#### **2.3 Prevention strategies: environment**

#### *2.3.1 Hospital design*

*"We shape our buildings and afterwards our buildings shape us." Winston Churchill*

Evidence-based design is a term used to describe how the physical design of health care environments affects patients and staff [9]. Key characteristics of evidencebased design in hospital settings include single-patient rooms, use of noise-reducing construction materials, easily accessible workstations, and improved layout for patients and staff [10].

Several scholars highlighted that Evidence based design for built environment can lower the incidence of nosocomial infections, medical errors, patient falls, and staff

injuries [11]. Patient safety can be enhanced through flexibility and adaptability. The following need to be ensured:

