Finnish patient safety strategy 2009-2013

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

The first Finnish patient safety strategy was published in January 2009. The strategy was developed by the Steering Group for the Promotion of Patient Safety set up by the Ministry of Social Affairs and Health in 2006. The main objective of the strategy is that patient safety will be embedded in the structures and methods of operation in health care.It focuses for example on improving patient involvement, proactive risk management and reporting of safety incidents.

Purpose of health policy or idea

The first Finnish patient safety strategy was published in January 2009. The main objective of the strategy is that patient safety will be embedded in the structures and methods of operation in health care. This will be pursued by

1. active involvement of patients in improving patient safety, 
2. managing patient safety proactively and through learning, 
3. improving reporting of patient safety incidents and learning from them, 
4. strengthening systematic promotion and resources of patient safety activities, 
5. taking patient safety into account in healthcare research and teaching.

The responsibility for the implementation on the national level lies in the National Institute for Health and Welfare (THL).

The strategy outlines, for example, that every provider organization should have clear procedures for internal reporting, monitoring and handling of errors and patient safety incidents. Organizations should have comprehensive risk and quality management systems and agreed procedures for the aftercare of adverse events. They should have a patient safety plan and appointed persons coordinating the promotion of patient safety. Also organizations should use the national information on patient safety indicators for promoting patient safety and learn from each other to develop a patient safety culture. They should have the resources for making surveys of patient safety promotion and take part in research projects in the field.

At the national level, THL is to support the practical implementation of the strategy and its embedding in different healthcare units, develop equipment and methods of work, promote research on patient safety, monitor the development of patient safety by means of national indicators, further national cooperation between social and healthcare organisations and take part in international cooperation in the field.

The strategy also requires that patient safety will be integrated in primary education and continuous medical education.

Main points

Main objectives

The objective of the strategy is to increase patient safety by embedding supporting structures and methods into the healthcare system.

Type of incentives

Increased quality of health services

Groups affected

providers, health care professionals, patients

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral

The policy is rather innovative in the Finnish setting. Patient safety has really surfaced on the health policy agenda in last few years. However, from an international perspective this is not as novel. Although patients are in the centre of the policy, public visibility has been very low. One reason for that could be that the policy is rather consensual. Actors directly involved in the process strongly try to portray the patient safety issue from a positive perspective, while a negative framing of the issue could be more attractive to the media.

Political and economic background

Patient safety has been raised on the health policy agenda in Finland during the last years, paralleling the activities on patient safety and quality at the EU level, OECD and in the Nordic collaboration. The Ministry for Social Affairs and Health (MSAH) has been the main actor in the developing of the new approach by following European developments in the field and launching the drafting of the strategy by nominating the steering group for the task.

MSAH activities really started in 2005 when a patient safety network was established. The network includes about 200 members representing healthcare professionals, healthcare providers, patients, non-governmental organizations and authorities. Before that, from the year 2003 onwards the Finnish Medical Association (FMA) has raised patient safety on its agenda. An important driver for this was that the issue had been discussed by other national medical associations in the EU. FMA held a seminar on patient safety and conducted a survey among healthcare units in 2003. Many other organizations had also been active in the first half of the 2000's: for example the Association of Finnish Local and Regional Authorities, the Finnish Patient Insurance Centre, the National Research and Development Centre for Welfare and Health (STAKES) and the Finnish Medical Society Duodecim. The first pilot projects for reporting patient safety incidents started in Finland in 2004. Before this decade, patient safety issues have been discussed only as a part of healthcare quality issues.

Important international background drivers were patient safety activities of the WHO (World Alliance for Patient Safety program, since 2004), activities of an expert group of the Council of Europe (2003 onwards), and activities within the European Union. Also the Nordic Council and OECD had been active in this matter before the steering group was set up.

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Origins of health policy idea

The strategy was prepared by the steering group for the promotion of patient safety set up by the Ministry of Social Affairs and Health in 2006. This was first patient safety strategy in Finland. The group included a variety different stakeholders: the Ministry of Social Affairs and Health, the Association of Finnish Local and Regional Authorities, the Finnish Patient Insurance Centre, the National Research and Development Centre for Welfare and Health (STAKES), the National Public Health Institute, the Finnish Institute of Occupational Health, the National Agency of Medicines, the National Authority for Medicolegal Affairs, the Centre for Pharmacotherapy Development ROHTO, primary care providers, secondary care providers, private providers and patients.

Initiators of idea/main actors

• Government

• Providers

• Payers

• Patients, Consumers

• Others

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

The launch of the patient safety strategy was a major milestone in the process to put patient safety on the agenda of the healthcare system. It was the first national level policy paper explicitly focusing on this issue. A few key actors from different organizations have had an important role in pushing the process forward at the national level. The next step is to raise awareness for the topic at the provider level. Awareness for the issue of patient safety has increased slowly, but steadily. All stakeholder groups consider patient safety as an important theme, but part of the healthcare professionals, especially physicians, do not recognize the need to pay special attention to it. 

Actors and positions

Government
Ministry for Social Affairs and Health	very supportive		strongly opposed
National Research and Development Centre for Welfare and Health (STAKES)	very supportive		strongly opposed
Providers
Public providers	very supportive		strongly opposed
Private providers	very supportive		strongly opposed
Payers
Association of Finnish Local and Regional Authorities	very supportive		strongly opposed
Patients, Consumers
Patients	very supportive		strongly opposed
Others
Finnish Medical Association	very supportive		strongly opposed

Influences in policy making and legislation

Patient safety is planned to be integrated in the new Health Care Act (see HPM 12/2008). It is planned that the act is going to permit the government to issue a separate lower level degree on patient safety. It is estimated that the bill is going to be passed by parliament in the course of this year.

Legislative outcome

pending

Actors and influence

Government
Ministry for Social Affairs and Health	very strong		none
National Research and Development Centre for Welfare and Health (STAKES)	very strong		none
Providers
Public providers	very strong		none
Private providers	very strong		none
Payers
Association of Finnish Local and Regional Authorities	very strong		none
Patients, Consumers
Patients	very strong		none
Others
Finnish Medical Association	very strong		none

Positions and Influences at a glance

Adoption and implementation

Responsibility of the implementation at the national level lies with the National Institute for Health and Welfare (THL). But service providers and healthcare professionals play an even more important role in the implementation.

Monitoring and evaluation

Monitoring and evaluation is to be carried out by the National Institute for Health and Welfare (THL). However, the strategy does not explicitly define how it should be conducted.

Dimensions of evaluation

Process, Outcome

Expected outcome

So far, the process has successfully put the issue of patient safety on the health policy agenda at the national level. However, the key to successful implementation lies in the hands of service providers and healthcare professionals. The key question is how to increase understanding among providers and healthcare professionals that patient safety is something that really needs attention and that there is the possibility to increase the quality of services by implementing measures improving patient safety.

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high

If successfully implemented, policy will have a positive impact on the quality of healthcare services.

References

Sources of Information

Promoting patient safety together. Finnish Patient Safety Strategy 2009-2013. Ministry for Social Affairs and Health. Publications 2009:5. www.stm.fi/c/document_library/get_file?folderId=39503&name=DLFE-8037.pdf.

www.who.int/patientsafety.

Author/s and/or contributors to this survey

Lauri Vuorenkoski

Suggested citation for this online article

Vuorenkoski, Lauri. "Finnish patient safety strategy 2009-2013". Health Policy Monitor, October 2009. Available at http://www.hpm.org/survey/fi/a14/1