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Patient Safety in Office Practices



A collaboration led by the Massachusetts Department of Public Health
partnered with
Brigham and Women’s Hospital,
Institute for Healthcare Improvement,
Massachusetts Coalition for the Prevention of Medical Errors,
Coverys, CRICO, Harvard School of Public Health, Harvard Medical School,
Health Care For All, and the Massachusetts Medical Society

The PROMISES (Proactive Reduction of Outpatient Malpractice: Improving Safety, Efficiency, and Satisfaction) Project was funded by the Agency for Healthcare Research and Quality (AHRQ) to teach improvement skills to small and medium-sized primary care practices across Massachusetts. In addition, sites received coaching to test interventions utilizes tools for strengthening key processes related to patient safety.

The PROMISES project, a randomized controlled trial, worked directly with 16 pilot practices and investigated an addition 9 control practices. Pilot practices learned how to address inefficient and ineffective processes related to patient safety and reduce the risk of a medical malpractice lawsuit. The PROMISES project evaluated the intervention using survey and chart reviews as well as qualitative exit interviews with participants (survey and chart review instruments are available on this website).

Coaches from the PROMISES project visited 16 primary care offices and worked directly with improvement teams on key challenges that lead to malpractice. Specifically, teams applied new ideas related to (1) test results management (2) referral management (3) medication management. In addition, many teams addressed communication challenges with patients and among care teams.

These 16 practices also shared their experiences in a learning network. By addressing their challenges and learning from other teams, practices felt they saved time and improved the quality of care

What physicians and practice managers said about the PROMISES project

“...it was incredibly helpful.”
“The PROMISES program works. Attacking it in small fundamental bites, and mapping out the process, and finding out where the actual problems are, is a process that I hope everyone learns.”
“As we did it piece by piece..., it really wasn't a lot of time, and the changes we made were so significant...”
“when you look back now, you think, "how did we not do that 18 months ago?”
“We were able to conquer things that we did not even know existed... that is so wonderful and important in my practice, and I am so grateful for it.”
“I think the number one [benefit] was being more aware of the fact that there are areas to change, and number two was this idea of small tests of change can start small. And number three is going back and looking at the change, measuring it and testing it by asking -- did your hypothesis actually work?”

Learning Materials

Sample Learning Materials

Find all the lectures and case studies here »

How to use this material

Individuals and teams should use these materials to improve patient safety. To fully implement these videos and tools, the PROMISES Partners recommend using the curriculum coupled with practice coaches and a collaborative learning network to support the learning and maximize improvement.

Learn from the materials offered here or contact us if you are a Massachusetts healthcare provider interested in developing your own patient safety program.

* This project was supported by grant number R18HS019508 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ.

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