Common Formats, Collaborative Learning: The Art and Science of Patient Safety

A longstanding adage among healthcare providers is that medicine is both an art and a science. For centuries, the balance was tilted heavily in one direction; when physicians understood little about human physiology, the practice of medicine was often more of an art. Contemporary physicians tend to think of the scales as being tipped in the other direction—for individual patients, contemporary caregivers have a working knowledge of the science behind how the human body is supposed to work (physiology) to better diagnose where things go wrong (pathophysiology).

Still, as Karen Zimmer, M.D., M.P.H., FAAP, clinical director, ECRI Institute PSO, and assistant professor, Johns Hopkins University, notes, “medicine remains a balancing act between art and science. Even as the science of how the human body functions is better understood, it’s balanced by the art of a focused therapeutic plan for an individual patient.” And, she adds, for as much as our understanding is improved by advances in science, much is still unknown, and caregivers must still use their creativity to question what is known and conduct studies to better understand the processes of disease.

Just as there are gaps in knowledge and a blend of art and science in caring for individual patients, there are also gaps and a need for innovation in understanding how healthcare delivery systems work and how best to affect change that ensures quality. And just as centuries of science were necessary to reach our contemporary understanding of peoples’ physiological systems, research in the dozen years since the release of the Institute of Medicine’s To Err Is Human has focused on understanding delivery systems that affect outcomes.

Zimmer and John R. Clarke, M.D., clinical director, Pennsylvania Patient Safety Authority; clinical director for patient safety, ECRI Institute; and professor of surgery, Drexel University (Philadelphia), draw an analogy between the evolution of medicine in the care of individual patients and the progress of patient safety on a larger scale. Before caregivers can be sure that patients are receiving safe care, they need to first understand the infrastructures or inner workings—the physiology—of the hospital, Zimmer says. Then they can better understand how breakdowns occur—its pathophysiology. Patient safety research is in its infancy compared with medical research, but caregivers need to begin to understand processes and systems and use evidence-based practice when possible to develop guidelines in the care of patients. By exploring medicine through the lenses of the frontline staff, nurse managers, attending physicians, trainees, and administrative...