156-909 / Implementation of a Patient Safety Model in Primary Healthcare at Regional Level in Catalonia

GOP Information
Organisation sharing the GOP
Related practices from PaSQ database
Directorate-General of Ordination, and Health Regulation


Quality improvement project
Clinical risk management
Implementation of Patient Safety initiatives / Activities
Patient safety culture / Patient safety climate
GOP Description
Implementation level
Clinical settings
380 primary care centers . In the lines identified for improvement
To implement
1.     The primary care patient safety management strategy for the PCT of Catalonia to achieve healthcare safety excellence.
2. The primary care patient safety model to identify risks in critical areas of healthcare and to promote the required improvements so as to minimize the risks associated with healthcare.
Identify the patient safety standards from the PCT accreditation model.
Using a modified Delphi method in two rounds, the consensus panel was asked to identify the standards related to patient safety and to select which should be regarded as indispensable or sine qua non, i.e., the standards that in a PCT guarantee the minimum risk of unnecessary harm associated with healthcare.
In the first round, 235 standards from the 379 standards of the accreditation model were identified as patient safety standards. Of the 235, 28 were considered sine qua non.
After eliminating the standards that had not been selected, the consensus panel reassessed the selected 235 standards in a second round.
Later, a total of 28 standards were further excluded, and five more were included in the sine qua non subgroup.
As a result, the patient safety model includes 207 standards. Of these, a subgroup of 33 was considered indispensable or sine qua non.
Forty-four PCT (phase 1) will participate in a pilot study to validate the patients safety standards of this model. The study will evaluate the degree of compliance with the standards in these PCT and will identify common critical areas to implement improvements at an institutional level.
Timeframe implementation
(Pilot study 2011-2012) 2011-2015
Implementation tools available
MOSPS pre and post intervention

Reporting system and incident / adverse events .

Patient Safety Plan

Standards sine qua non : standards of patient safety in primary accreditation questionnaire

PS Scorecard

Plan training in Patient Safety

Self Assessment sine qua non


Implementation cost
400.000€ (Together with hospitals project)
Method used to measure the results
In order to achieve the second goal, the degree of compliance with the Patient Safety Model (PSM) standards was assessed and the common critical areas were identified in 40 primary healthcare centres (HC), with the purpose of defining institutional improvement actions. An HC assessment instrument was created so that each HC’s general manager and/or quality and safety manager could perform the self-assessment. Subsequently, fieldwork was carried out in each HC, consisting of an audit requiring, on average, about 8 hours to complete. Finally, a safety programme framework document was designed to provide each HC with a tailored programme identifying their critical areas and to devise an action plan aimed at improving them. (See attached file)
– Design and validation of the PC PSM
– Implementation of the patient safety management strategy in PC. Results of the audit performed in accordance with the PSM
Please see the attached file for detailed results.
Analysis of the results
See the attached two slides.
We now have a patient safety management model for PC that enables us to establish common strategies for all teams, targeting particularly those standards where most HCs are experiencing difficulties in compliance, and also to create customised improvement programmes focusing on the standards in which each HC scores lowest.
There is room for improvement in the following sine qua non standards:
•    Medicine use in the centre (storage, expiry, cold chain, multiple dose delivery systems), drug surveillance and reporting of medication errors.
•    Aspects related with the preventive maintenance of medical devices.
•    Training plan and the specific training in cardiopulmonary resuscitation and use of medical devices.
•    Quality plan, with a defined patient safety strategy.
•    Infection surveillance, prevention and control process.
In order to guarantee safer care, we must promote the safety culture among health professionals and design safer processes, engaging with all agents who provide health services, including health policy planners and the professionals who drive good practices. All health professionals, patients and the other agents in the system must be informed participants. Although human errors may occur, measures must be taken to systematically diminish their underlying causes.
Implementation barriers
Did you find implementation barriers?
Please describe implementation barriers
Resistance to change

Lack of safety culture

Economic crisis

Diversity typology of centers (private facilities)

Great number of Primary care team

Describe the strategies used to overcome the barriers (If needed)
Communication .
Common project : security is everyone’s business.
Patient periodical Safety Conference .
Other information
Other information about the GOP that you would like to add (Link or attached document)