Rapport Patiëntveiligheid, de rol van de bestuurder - Veilige zorg ...

Safety issues became more visible and at the same time a system of continuouslearning and improvement evolved. In the three cases the professionalsprovided the subject-matter expertise whilst the board played an initiatingand supporting role. This led to professionals becoming problem-owner andto improvement recommendations that could be implemented with little orno board level pressure. An example is that from the first 8 HFMEA reports,85% of the 96 recommendations were implemented whilst there was nocontrol al all by the board. Five years later, 66% of these were still in effect,showing the sustainability of the recommendations. The RCA’s and HFMEA’salone led to over 120 safety improvement, implemented in first two years.The analysis – strategies usedThe empirical findings largely confirm the hypothesis that was based on thetheory. Two strategies were used that had not been found in the literature:appeal and support. These form an addition to the existing theoreticalframework on process management. The empirical findings show that thefollowing strategies were used for process management:- Openness: everybody was able to provide input;- Safety: each participant’s core values were protected;- Momentum: the process kept its momentum;- Ratio: the outcome was rational;- Appeal: the subject appealed to the healthcare professionals;- Support: there was enough support so professionals could focus oncontent.These six strategies are strongly related to each other. Each strategy leads to acounterforce which is subsequently mitigated by the next strategy. Opennessleads to unpredictability because anybody can influence the agenda. This canmake it unsafe to participate, because participation might lead to an unfavorableoutcome. Therefore participation must be safe. But if each participant’score values are protected but the values are opposed to each other, theprocess is prone to grind to a halt. Pressure is essential to keep momentum.Too much pressure can however lead to the process falling apart or endingin a meaningless or senseless outcome. Therefore, strategies must be used tomake sure the outcome is rational. Even if this is done right, it still does notguarantee that professionals will be willing to invest time in the process. Forthis they must be intrinsically motivated, it must be appealing to them toengage. Participating costs time and this can be a reason for professionals tohold back. Therefore there must be ample support (e.g. planning, maintain-386summary