**4. Formulation of objectives and identification of the content of patient safety curriculum**

The main addressed areas into the content of the patient safety include; good communication skills, development of team work skills, improving skills of managing risks and solving problems while a harm was detected for the patient [11].

#### **4.1. Models of patient safety curriculum**

#### **I. The Australian Patient Safety Education Framework**

It is a model for learning patient safety includes different seven areas with 22 topics and describes knowledge and performance that are required form each personal in the health system in order to provide safe care. Each objective is divided into four levels. Each level includes a category according to the position or the responsibility of each individual.

The seven areas are as follow:


#### **II. The Canadian Framework (The safety competencies – Enhancing patient safety across the health professions)**

This framework is an inter-professional, and it includes six domains which are as follow: contribute to a culture of patient safety; Work in teams for patient safety; Communicate effectively for patient safety; Mange safety risks; Optimize human and environmental factors; Recognize, respond to and disclose adverse events [2]. Each domain contains the needed knowledge, skills, and attitude.

#### **III. Scottish Patient Safety Fellowship**

Formulating the rational and assessing the needs of the healthcare professionals are essential

The main addressed areas into the content of the patient safety include; good communication skills, development of team work skills, improving skills of managing risks and solving

It is a model for learning patient safety includes different seven areas with 22 topics and describes knowledge and performance that are required form each personal in the health system in order to provide safe care. Each objective is divided into four levels. Each level includes

• Communicate effectively: patients and their carers are among the health team. They are considered as a second pair of eyes for a doctor. Communicating effectively will reduce the risk for patients. This area includes involvement of both patients and their carers in their health care, communicating risk, obtaining consent, being honest, and being knowledge-

• Using evidence: in this area, health care workers should know and apply principles of

• Adverse events: we cannot reduce errors unless we know causes and nature of errors. Most adverse events are system failure determined rather than professional carelessness or misconduct. In this area individuals should learn how to record errors, to perform quality

• Working safely: this area is about teamwork and knowing roles and responsibilities within the healthcare team. It includes leadership, understanding complex organization, human

• Being ethical: health care workers should know and apply ethical codes of practice and

• Learning and teaching: health care information expands rapidly and continuously, so health care workers need to continuously update their knowledge and skills, and this

• Specific issues: this area is to ensure that the right treatment is delivered to the right patient,

a category according to the position or the responsibility of each individual.

evidence-based practice in their work and use information technology.

measure, and to improve performance, managing risks and complains.

and to eliminate wrong procedure and site, and to medicate safely [3].

factor, continuity of care, and managing fatigue and stress.

requires learning and teaching in the workplace.

steps for formulating objectives and identification of the course content.

problems while a harm was detected for the patient [11].

**I. The Australian Patient Safety Education Framework**

**patient safety curriculum**

92 Vignettes in Patient Safety - Volume 3

The seven areas are as follow:

**4.1. Models of patient safety curriculum**

able and sensitive to cultural difference.

maintain their fitness to practice.

**4. Formulation of objectives and identification of the content of** 

It includes six topics and general aims to be fulfilled.

**1.** Improvement theory, methods and tools

a. Theory of profound knowledge b. Model for improvement c. Quality improvement as core business strategy d. Planned experimentation.

**2.** Leading clinician through change.

a. From stable delivery model to adaptability and growth within an organization. b. Principles and difference of adaptive versus technical changes. c. Building a compiling case for change. d. Developing a shared vision. e. Sponsorship, champions, alignment and feedback f. compacts

**3.** Measurement for improvement.

a. Data, variation, reporting b. Measure for improvement versus research and judgment


#### **IV. WHO patient safety curriculum guide**

World Health Organization provided a Multi-Professions Edition of Patient Safety Curriculum Guide to assist the health professions institutions in implementing the curriculum of patient safety. The guide includes some suggested topics, teaching, and evaluation methods for preparing students who have the knowledge, skills, and attitude for improving their clinical practice and patient safety. Each institution after performing a needs assessment, could integrate these topics into its curriculum. A medical guide was produced by the WHO in 2009; the multi-professional edition was developed after consulting dentists, nurses, midwives, and pharmacists. The guide is divided into two sections: part A: Teacher Guide; and part B: patient Safety Topics. The Teacher Guide helps to build the capacity of the educators. It offers information about the efficient instructional methods to teach the topics and suggested techniques for integrating the module into the existing curriculum. The patient safety topics are suggested to be implemented as parts or as a whole [4].

The guide covers 11 topics and includes 16 subtopics which were selected from the Australian framework. The 11 WHO topics are shown in **Table 1**.

#### **The listed topics in WHO guide**


**5.** Topic 5: understanding the learning from errors

**6.** Topic 6: understanding and managing clinical risk

**7.** Topic 7: introduction to quality improvement methods

process is incorporated into the system is essential [4].

**10.** Topic 10: patient safety and invasive procedures

**11.** Topic 11: improving medication safety

based and directly linked to the content [9].

**9.** Topic 9: minimizing infection through improved infection control

**8.** Topic 8: engaging with patients and carer

ship and communication.

to be learned.

errors pre operatively.

tion or calculation errors.

than blaming individuals for their errors [3].

The poorly designed systems have contributed to making errors. Students should understand and appreciate happening of these errors to prevent their occurrence in the future. This systems-based approach and knowing the factors contributing to the cause of the errors is better

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Risk management is a process of recognizing, dealing with and preventing risks. Clinical risk management is recognizing the events that could harm the patients and ways to prevent them from occurring again. Information that are emerged form patients' complaints, incidents, legal cases related to health care, can be used to set strategies for clinical risk management [2].

Quality management methods have been introduced from industries to healthcare. Students should be able to identify problems, measure the problem, develop strategies to fix this problem, and test whether these strategies worked or not. Knowing how every step in health care

Students should understand and appreciate the role of the patients and their carers in the diagnosis and compliance with treatment. The outcomes of the treatment and the prognosis can be enhanced and the adverse effects could be reduced by the good patient-doctor relation-

Hospital-acquired infection and healthcare associated infection are major causes of death and disability worldwide. Patients with invasive procedures are particularly predisposed to hospital-acquired infections. How to apply preventative measures and guidelines is crucial

Miscommunication between healthcare providers before carrying out surgeries leads to perform wrong procedures, in the wrong sites for wrong patients. This is the main source of

WHO has defined adverse drug reaction as any harmful response to medication, which is unintended and occurs at amounts used for prophylaxis, analysis or treatment. The main causes of medication errors are induced by low knowledge about the patients or the medica-

Concerning the learning outcomes in patient safety curricula, they should be competency-

**Table 1.** The eleven topics presented in the WHO patient safety curriculum guide.

**1.** Topic 1: what is patient safety?

This topic presents the patient safety principles and concepts as a response to the requirement of healthcare professionals aiming to incorporate these principles and concepts into everyday practice [4].

**2.** Topic 2: what is human factor and why it is important to patient?

Students need to recognize how human factor can be used to decrease adverse events and errors by detecting how and why systems break down and how and why human beings miscommunicate. Using a human factor method, the human-system interface can be enhanced by providing systems and procedures which are better designed. This often involves improving communication, simplifying processes, and standardizing procedures [4].

**3.** Topic 3: understanding systems and the impact of complexity on patient care

The concept that a healthcare system is made up of different units that provide multiple services and practices should be introduced all healthcare workers. The complexity of health system increases by the existence of relationships between health care providers, patients and their career, supporting staff, administration, and community members. This topic introduce the concept of complex organization to students by using a system approach [4].

**4.** Topic 4: being an effective team player

This topic includes the fundamental knowledge required to be an effective team member. The importance of effective multidisciplinary teams for improving care and reducing errors. Students need to understand the culture of their workplace and how it influences team dynamics and functioning [3].

#### **5.** Topic 5: understanding the learning from errors

The poorly designed systems have contributed to making errors. Students should understand and appreciate happening of these errors to prevent their occurrence in the future. This systems-based approach and knowing the factors contributing to the cause of the errors is better than blaming individuals for their errors [3].

#### **6.** Topic 6: understanding and managing clinical risk

Risk management is a process of recognizing, dealing with and preventing risks. Clinical risk management is recognizing the events that could harm the patients and ways to prevent them from occurring again. Information that are emerged form patients' complaints, incidents, legal cases related to health care, can be used to set strategies for clinical risk management [2].

#### **7.** Topic 7: introduction to quality improvement methods

Quality management methods have been introduced from industries to healthcare. Students should be able to identify problems, measure the problem, develop strategies to fix this problem, and test whether these strategies worked or not. Knowing how every step in health care process is incorporated into the system is essential [4].

**8.** Topic 8: engaging with patients and carer

**1.** Topic 1: what is patient safety?

**The listed topics in WHO guide** Topic 1: what is patient safety?

94 Vignettes in Patient Safety - Volume 3

Topic 4: being an effective team player

Topic 8: engaging with patients and carers

Topic 11: improving medication safety

Topic 10: patient safety and invasive procedures

Topic 5: understanding and learning from errors Topic 6: understanding and managing clinical risk Topic 7: introduction to quality improvement methods

**4.** Topic 4: being an effective team player

dynamics and functioning [3].

practice [4].

[4].

This topic presents the patient safety principles and concepts as a response to the requirement of healthcare professionals aiming to incorporate these principles and concepts into everyday

Students need to recognize how human factor can be used to decrease adverse events and errors by detecting how and why systems break down and how and why human beings miscommunicate. Using a human factor method, the human-system interface can be enhanced by providing systems and procedures which are better designed. This often involves improving communication, simplifying processes, and standardizing procedures

The concept that a healthcare system is made up of different units that provide multiple services and practices should be introduced all healthcare workers. The complexity of health system increases by the existence of relationships between health care providers, patients and their career, supporting staff, administration, and community members. This topic introduce

This topic includes the fundamental knowledge required to be an effective team member. The importance of effective multidisciplinary teams for improving care and reducing errors. Students need to understand the culture of their workplace and how it influences team

**2.** Topic 2: what is human factor and why it is important to patient?

**Table 1.** The eleven topics presented in the WHO patient safety curriculum guide.

Topic 2: what are human factors and why is it important to patient safety? Topic 3: understanding systems and the impact of complexity on patient care

Topic 9: minimizing infection through improved infection control

**3.** Topic 3: understanding systems and the impact of complexity on patient care

the concept of complex organization to students by using a system approach [4].

Students should understand and appreciate the role of the patients and their carers in the diagnosis and compliance with treatment. The outcomes of the treatment and the prognosis can be enhanced and the adverse effects could be reduced by the good patient-doctor relationship and communication.

#### **9.** Topic 9: minimizing infection through improved infection control

Hospital-acquired infection and healthcare associated infection are major causes of death and disability worldwide. Patients with invasive procedures are particularly predisposed to hospital-acquired infections. How to apply preventative measures and guidelines is crucial to be learned.

#### **10.** Topic 10: patient safety and invasive procedures

Miscommunication between healthcare providers before carrying out surgeries leads to perform wrong procedures, in the wrong sites for wrong patients. This is the main source of errors pre operatively.

#### **11.** Topic 11: improving medication safety

WHO has defined adverse drug reaction as any harmful response to medication, which is unintended and occurs at amounts used for prophylaxis, analysis or treatment. The main causes of medication errors are induced by low knowledge about the patients or the medication or calculation errors.

Concerning the learning outcomes in patient safety curricula, they should be competencybased and directly linked to the content [9].

To ensure patient safety, the future physician must be prepared to know potential sources of errors and to recognize their own susceptibilities to error. An elective course in the open disclosure of the health care providers, which is communicating with the patients the errors and how it happened, can be introduced. This training of disclosure may decrease the harm of the future patients [16].

medical students are positive about learning with other students who participated in clerk-

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The course may include interactive lectures, e.g. problems with inappropriate supervision by a physician, to highlight the relation between theory and practice. Then the students had to reflect on incidents concerning patient safety based on their own personal experience and to complete an incident report card for each of these incidents. The course may also include presentations arranged by the students, which are followed by a 10-minute discussion for each presentation. Assessment of the students includes content, structure and presentation techniques [10].

Most courses in patient safety were introduced by lecturing and discussion which have short terms positive changes but the transfer of knowledge to the practice is low [9]. Learning patient safety could be enhanced by reflection, feedback, portfolio, and critical incident analysis, case discussions with senior clinicians, simulation environments and workshops. So, patient safety courses based on personal experiences and reflections enable students to transfer knowledge into practice and have a high impact on future career [10]. Some studies reveal that students emphasized active learning and experiential activities to reinforce safety

Patient safety is highly contextual, so, students should have adequate professional practices to learn patient safety, in this regard patient safety is best taught once students involved in the health services. However, some behavioral sciences-based subjects could be learned early such as; what is patient safety, what are human factors, and understanding systems modules. Students need to continuously reflect on their practices and apply the learned knowledge and performance to be a safer provider of health care. Using critical cards incidents to help students reflecting on their

Advocates of patient safety are usually from administrative nonacademic staff. To integrate patient safety throughout the curriculum we need a large number of academic teachers who often are not familiar with concepts and principles of patient safety. Some of them may practice patient safety principles without being aware of such knowledge. Academic clinicians, administrators, nurses, engineers, behavioral scientists are all involved in teaching patient safety. They should have capacity building through training workshops and seminars. Some schools trained healthcare administrators to deliver patient safety curriculum for undergraduates' students [9].

From the point of view of the tutors who were involved in the implementation of the patient safety curriculum, some recommendations emerged. For example, training of the tutors, and the participation of large number staff in implementation, which will reduce the load on one or two

personal experiences seems to be useful in improving the transfer of knowledge [10].

• Experiential/ Provides opportunities for application and reflection

ships of different specialties

principles [18]. • Contextual.

**5.2. Limitations**

**5.1. Who should teach patient safety?**

The course of patient safety necessities to be more focused. Writing objectives that are specific to the learners, measurable and relevant to their needs, help to focus the content course and essential for planning the appropriate instructional methods of conducting the course.
