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Improving patient safety: an economic perspective on the role of nurses.

AIMS
This paper synthesises patient safety research and insights from economic theory to generate guidance for nurse managers. The paper describes the key roles nurses and nurse managers can play in improving patient safety, and explains how insights from health economics can help inform and enhance this role, helping nurse managers to set priorities for improvement and for future research.


BACKGROUND
Awareness of the need to improve patient safety is high, but insufficient attention has been paid to the cost-effectiveness of safety improvements, leading to difficulty in setting priorities. This paper suggests specific methods that nurses can and should use to prioritize and evaluate safety improvements.


EVALUATION
This is a review article, synthesising the results of research on patient safety.


KEY ISSUES
Because of their close connection to patients, nurses (and nurse managers in particular) have key roles to play in improving patient safety. Improving patient safety will also benefit nurses and other practitioners directly, because caregivers suffer lasting distress from being involved in incidents that harm patients. Reducing harmful incidents should also reduce attrition and alleviate chronic staffing shortages. Insights from health economics can help nurse managers to set priorities for improvement and to more effectively evaluate the changes made.


CONCLUSIONS
Evidence on the costs and effects of most safety improvements is still lacking. Nurses can and should take a leadership role in implementing changes and evaluating their costs and effects.


IMPLICATIONS FOR NURSING MANAGEMENT
To lead improvements in patient safety, nurse managers need to learn to use the Plan-Do-Study-Act Improvement Cycle, and need to develop an awareness of and ability to measure the costs and effects of changes. These changes would allow nurse managers to better make the business case for patient safety.