Physicians actually can do a lot to improve patient safety in their practices. One of the most important things may seem to have little to do with clinical care. Championing and ensuring an office culture that supports patient safety is a critical framework that is the basis for patient safety and quality improvement efforts.

Part of this has to do with making better communication and teamwork a priority within the office – from the receptionist to your physician and nurse colleagues. This includes empowering staff to speak up when they see a problem and encouraging them to report mistakes – including near misses – so that everyone can learn from them and keep them from happening again. This might also include periodic meetings to identify and learn from communication / teamwork failures.

AHRQ is preparing a new tool for release later this year that can help physicians in medical offices measure your patient safety culture and use the results to target areas for improvement. (It's similar to what we've already produced for the hospital setting –the Hospital Survey on Patient Safety Culture.)

Practices also can incorporate available tools and tips to help improve communication and teamwork through TeamSTEPPS™, a team-training curriculum developed by AHRQ and the Department of Defense.

Another option is to put health information technology to work for you in your practice—whether it's through computerized order entry to help prevent errors with prescriptions or by implementing electronic health records, or EHRs, for your patients. When used optimally, EHRs can, for example, identify patients with diabetes who have not received a foot or eye exam and even send reminders to your staff and your patients when needed. In this way, EHRs can significantly augment the work of clinical and administrative staff, head off potentially serious complications, and thereby ultimately improve the quality of care your patients receive.

One of the first things you may want to do is assess your current status in terms of organization-wide patient safety and compare that to where you want to be. This kind of review can help identify the most important patient safety issues to address. Talking to staff – and even engaging patients – can also provide good information and key insights to help focus a successful improvement strategy.

It's also helpful to develop a measurement strategy before beginning an improvement effort. It will help you see improvement over time and show success. Benchmarking is an important initial component of a measurement strategy. Where data and information about similar practices is available, benchmarking and comparisons can help set reasonable goals and gauge progress throughout a quality improvement initiative.

After determining and prioritizing issues that might benefit most from attention and change, the next step is to identify the tools and resources that best fit your practice and are most likely to address those areas for improvement. One place to find out about some of the experiences others have had is AHRQ's Web site at www.ahrq.gov.

We know that it can be difficult to change established office routines and the dynamics and interaction styles of staff. An important lesson we are learning throughout health care, however, is that these fundamental factors really do influence the care that patients receive. In hospital settings, for example, we realize more and more that adopting a culture of patient safety and teamwork can be life-saving for patients.

Research shows that without support at all levels, patient safety and quality improvement efforts often fail. That's why support and buy-in for patient safety or quality improvement efforts must exist at all levels – from the receptionist who answers the phone, to the nurse who manages prescription refill requests, the lab tech who draws blood, or the office manager who requisitions supplies. Each staff member can contribute or detract from the quality of care that patients receive.

It's hard to measure what doesn't happen. And that's just what safe health care is all about – making sure that avoidable harms don't happen to patients. One way is to measure the delivery of proven practices (evidence-based guidelines) that we know make care safer or better for patients. For example, ensuring that each patient has his/her HbA1c level checked or receives an influenza vaccination according to prevailing evidence.

The National Quality Measures Clearinghouse™, which is supported by AHRQ, houses more than 100 diabetes-related health care quality measures – many of which were developed by the National Diabetes Quality Improvement Alliance.

In measurement, it's also important to identify a goal (usually the gap between actual care being delivered and optimal care) and document the baseline before beginning an intervention. Just as the progress in reaching treatment goals for a patient guides decisions about their care, so too should quality data for a practice help identify the types of action needed to meet performance goals.

A coordinated approach to care for all chronically ill patients, especially those with diabetes is essential. For example, AHRQ's Medical Expenditure Panel Survey finds that only 9.8% of patients with Type II diabetes have only diabetes; the rest have one or more additional chronic illnesses. So promoting effective coordination for patients with diabetes could go a long way toward delivering patient-centered care. We know that one period when patients are particularly vulnerable to medical errors and suboptimal health care quality is during transitions between settings of care or between providers. Mistakes that are often the result of communication failures and incorrect or inadequate information are more likely to happen during transitions of care. AHRQ supports research that aims to identify solutions that mitigate or eliminate factors contributing to errors and poor quality care resulting from transitions.

I am particularly excited about a growing appreciation of the need for patient-centered care. Patient-centered care relies on a strong partnership among the provider team – which includes the primary care physician, endocrinologist, pharmacist, other specialists, and, most importantly, the patient and his or her family members. Care that is truly patient-centered enables shared decision-making to customize treatment plans, by which the team focuses squarely on the patient's needs and desires rather than on the demands of the health care system. AHRQ is also funding new research in this area designed to demonstrate how to use health information technology to support patient-centered care.

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