Patient safety surveillance

However, it is important to monitor and learn from patient safety events when they do occur, with patient safety forming an integral component of clinical governance.

The Health Service Act 2016 (external site) states that the Director General of the Department of Health WA’s role includes ‘overseeing, monitoring and promoting improvements in the safety and quality of health services provided by health service providers’. This monitoring or surveillance role is at the core of the Patient Safety Surveillance Unit at the Department of Health WA.

Patient Safety Surveillance Unit

The Patient Safety Surveillance Unit (PSSU) are policy custodians for three policies under the Clinical Governance, Safety and Quality Policy Framework:

• Clinical Incident Management Policy
• Complaints Management Policy
• Review of Death Policy

Through the above policies the PSSU monitors and reports on:

• Clinical incidents, which highlight areas where healthcare has or could have contributed to harm to patients. The investigation of clinical incidents identifies strategies to reduce the likelihood of similar situations reoccurring. The WA health system supports a ‘no blame’ culture so that clinical incidents are reported and lessons can be learnt. We take a systematic approach to patient safety which allows us to understand the nature and magnitude of clinical incidents and the factors that have contributed to their occurrence. Reporting of clinical incidents is supported by the web-based Datix Clinical Incident Management System (CIMS)
• Patient complaints, and other consumer feedback, which provide a valuable insight into the consumers health care experience and can identify areas for improvement. A no-blame culture that embraces and encourages consumer feedback as a learning opportunity can improve patient care and reduce the potential for future harm. Reporting of consumer feedback including complaints is supported by the web-based Datix Consumer Feedback Module (CFM)
• Reviews of death (mortality reviews) which provide valuable opportunities to examine the care provided to patients; to identify if the care was appropriate, whether it could be delivered differently or improved, and to evaluate the quality of end-of-life care and care during the terminal phase. Reviews of death may also identify cases where sub-optimal care may have contributed to the death of a patient, and that death may have been preventable.

The PSSU provides an oversight role for the implementation of these policies. Management of individual clinical incidents, complaints, and mortality reviews is undertaken by the WA health system hospitals and health services. The PSSU oversight role is at a case level for SAC1 clinical incidents.

Additional strategies to improve patient care include the review and implementation of health-related findings from coronial inquests and the identification and review of preventable patient deaths via the WA Audit of Surgical Mortality.

More information

Further information is available from the Patient Safety Surveillance Unit (WA Health staff only). This site contains clinical information and for this reason is only available to WA Health staff. Please contact PSSU@health.wa.gov.au for specific enquiries.