Background: Effective patient-and family-centered care requires a dedication to engaging patients and family members in health system redesign to improve the quality, safety, and experience of care. Provided here are lessons learned six years after establishing an infrastructure of patient and family advisory councils (PFACs) focused on improving health care quality and safety.Context: A large regional health care system with multiple hospitals and ambulatory care delivery sites in the eastern United States adopted a systemwide approach to Patient and Family Advisory Councils on Quality and Safety (PFACQS R ) in 2012.Approach: This conceptual article describes the barriers and facilitators of adopting, implementing, and sustaining the PFACQS model across a large, geographically diffuse health system. Successful strategies that emerged include active board engagement, co-creation and mentorship by experienced patient advocates to support enhanced engagement by local PFACQS community members, and clear alignment with and line of sight on organizational quality and safety goals.Conclusion: Implementing a robust network of PFACQS focused on improving quality and patient safety requires leadership commitment to transparency, as well as mutual respect and trust. Establishing clear guidelines, structures, and processes supports early adoption. Openness to continuous improvement and adaptations are important to program success and contribute to program sustainability.

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Objectives The aim of the study was to determine whether race differences exist in voluntarily reported harmful patient safety events in a large 10 hospital healthcare system on a high reliability organization journey. Methods From July 1, 2015, to June 30, 2017, employees in a healthcare system based in Washington, District of Columbia, and Maryland voluntarily reported harmful patient safety events by type using a Patient Safety Event Management System. Inpatients, outpatients, and observation patients were identified as “black,” “white,” or “other” (N = 5038). Using retrospective analysis and χ2 goodness of fit, comparisons of race proportions were conducted to determine differences at the health system level, by hospital, by event type, and by severity. Results Significant race differences existed: (1) overall with higher proportions of whites and lower proportions of other in a Patient Safety Event Management System; (2) by type across races; (3) in six hospitals across races; and (4) by type and by hospital for blacks and whites. All differences were significant at P < 0.05. Conclusions Race differences in harmful events exist in voluntary reporting systems by type and by hospital setting. Healthcare organizations, particularly healthcare high reliability organizations, can use these findings to help identify areas of further study and investigation. Further study and investigation should include efforts to understand the root cause of the differences found in this study, including the role of reporting bias.

Resilience engineering (RE) has ushered new approaches to learning about work in complex sociotechnical systems. In terms of improving safety, RE marks a shift from the traditional approach of retrospectively investigating adverse events, toward learning proactively about patterns in everyday work, including how things go well. This study applied the RE framework to the health care domain, by developing and implementing a new knowledge-elicitation protocol to learn about how frontline care providers achieve safe and effective patient care in their everyday work. Eighteen participants, including physicians, nurses, residents, and clinical leaders from a range of specialties, were interviewed using the new protocol. Qualitative analysis of the data revealed multiple themes and patterns which underlie resilient functioning of individuals, teams, and the organization as a whole. Further, a Resilience Mapping Framework (RMF) was developed based on major thematic categories to systematically represent and map various resilient capabilities—monitoring, anticipating, responding, and learning—across different levels of system scale, from the individual to the organizational. This study demonstrates new methods to identify and represent resilience not just during salient and critical “events,” but across the continuum of situations, from the everyday “normal” functioning to the critical.