Spain’s SENSAR makes a case for national incident reporting tool to improve patient safety

Dr. Daniel Arnal speaking at the 2018 World Patient Safety, Science & Technology Summit

Achieving a culture of safety in a healthcare organization requires transformational change which is owned and led by the executive leaders of the organization, including the board, and requires accountability and transparency. Sistema Español de Notificacion en Seguridad en Anestesia y Reanimacion (SENSAR), a non-profit organization led by anesthesiologists and based in Spain, has been leading the region’s patient safety initiatives since its founding in 2009.

In 2016, SENSAR partnered with the Patient Safety Movement Foundation, committing to implement a culture of safety in anesthesia, critical care, and pain management throughout all hospitals in Spain through the implementation of an independent, web-based, non-punitive incident reporting system.

“We joined the Patient Safety Movement because we shared the vision of helping to implement real tools to improve patient safety and we are fascinated with the audacity of the 0x2020 goal. Since then, Patient Safety Movement has provided SENSAR a great visibility for our work, connections with world patient safety leaders and showed us the power of patient testimonies to engage all the stakeholders in the same direction,”  explains Dr. Daniel Arnal, MD Anesthesiologist of the Hospital Universitario Fundación Alcorcón and President of SENSAR.

SENSAR, which is made up of more than 108 hospitals in Spain as well as a few in Chile, has leveraged their national reporting tool, the first of its kind in Spain, to help create widespread learning and system improvement following critical incidents. The incident reporting tool is anonymous and focuses on corrective measures, and lessons learned instead of blame. The result of this innovative reporting tool and their accompanying commitment to education has saved 6,772 lives since their commitment began in October 2016. 

SENSAR doctors gather for training

“Our incident reporting tool has had incredible outcomes in bringing the hospitals of Spain together in the name of patient safety. The participating hospitals have 200-1500 beds and are mostly public institutions and together count 504 analyzers, mostly anesthesiologists, that have already analyzed more than 7,400 critical patient safety incidents and suggested more than 15,000 related corrective measures,” explains Dr. Arnal.

He continues, “It’s difficult because healthcare is provided by different regions in Spain and each region has their own system. To bring everyone together, it’s a time-consuming process. We must talk to different heads of healthcare in each region.”

The effort has paid off. What began as a clinician-born initiative in 16 hospitals has grown from the bottom up and Dr. Arnal has seen local leadership improve.

Since making their commitment, SENSAR had 1250 incidents reported from doctors at 108 hospitals in 2017. As a result, more than 2700 corrective measures were proposed. Of which, more than 60% were implemented. As part of their commitment, SENSAR also publishes in the Spanish anesthesia society journal, where they discuss incidents, what can be learned from incidents, how to manage serious adverse events as well as national guidelines.

Despite the high number of incidents reported, Dr. Arnal believes there is more work to be done.

“Even in the best hospitals where the system is working properly, we think there is still much underreporting. The incidents that are not reported may not be that serious, but in a culture of learning, we believe you should always report. We aim for that but not know it may not be possible,” says Arnal.

The national incident reporting system is a powerful tool for correcting, educating and training. They provide patient safety education, protocol development, as well as success reporting and hospital engagement training.

“Our incident reporting system has given us many opportunities to learn and improve the conditions of local hospitals. It’s helped us build a strong education system. When hospitals report incidents, we can look for trends and provide training on how to deal with adverse events with transparency as well as how to use a reporting system.”

Among the educational events that SENSAR offers includes Anesthesia Patient Safety Course (twice a year), Crisis Resource Management simulation and team building courses (12 sessions per year) and Patient Safety lectures by SENSAR experts in every hospital. Thousands attend the educational events each year while SENSAR’s Anesthesia Crisis Book, which outlines serious adverse event protocols, has sold more than 6,000 books worldwide.

The non-profit’s education goes beyond healthcare providers. They’ve begun developing innovative programs, including a smartphone application called “I Want a Safe Surgery.” The app is a result of their design thinking workshops. The app will empower patients before surgery and teach how to be aware and advocate for patient safety. It has won a grant from the European Union, and a pilot program has begun in June 2018.

SENSAR also takes transparency seriously. As the adage goes, you cannot improve what you do not measure. SENSAR publishes a yearly report as well as encourages Incident and Analysis local report every four months.

“We have a lot of feedback that SENSAR has been a great asset to improve patient safety – not just our incident reporting tool, but we have changed the way people are thinking about problems and incidents. The President of the Spanish Society of Anesthesia has declared SENSAR the best patient safety initiative in Spain, ever, because what we are ultimately doing is creating change.

When you have a place where you don’t blame, and you focus on improving, the culture of safety improves. What started in our anesthesia department has now spread far beyond it.”

Arnal encourages others who have a vision for improvement to begin locally.

“We need commitments by leaders to act locally so that the effects of what we are working on can be seen by healthcare providers. If you take one tool and begin using it locally. Then add a simulation program and share the results in a network. From there, your efforts will grow.”