Laimutis Paškevičius


Patients have the right to safe and quality health care (HC). They contact hospitals  or other health care institutions (HCI) expecting help in restoringor strengthening health and do not expect to suffer any health damage or lose life. However, research shows that every tenth hospitalised patient suffers from adverse events (AE) resulting from shortcomings characteristic of a HC organisation orservice provision.
More than half of AE could have been prevented provided systematic prevention measures had been implemented. The prevalence of AE and their damage to patients, HC organisations, the entire HC sector and national economies remains unacceptably high. Implementation of actions to improve patient safety (PS) and ensure the provision of safer patient care has become the most important HC challenge of the 21st century.
Notwithstanding the extensive international PS movement that has emerged during the last two decades and plenty of international and national initiatives aimed at improving PS, a substantial breakthrough in ensuring safe patient care still remains a goal to be achieved. The main cause of disappointment is failure to implement international and national level PS improvement initiatives at the local (health care organization and its departments) level. There is no managerial adaptation mechanism to customize international and national level PS practices thus adapting them for hospital needs, specifics and potential.
The article presents and substantiates the comprehensive management model of PS events (Model) for hospitals and other HC organisations to use as a basis in developing and implementing comprehensive systems for PS management with the aim of more effectively expanding the scope of safe practices and implementing prevention of PS events as well as improving their management. The proposed Model consists of three structural blocks the integrated interaction of which is aimed at ensuring: (a) identification of the best international and national PS practice and its implementation at hospitals; (b) creation of conditions necessary to develop safe practice with the aim of ensuring and improving PS at hospitals; (c) detection, evaluation and development of safe practice; (d) comprehensive prevention and management of unsafe practice at hospitals thus ensuring and improving PS and contributing to the improvement of performance and achievement of the goals of the entire organisation.
The article discusses structure and functions of the Model, its integration witho ther activities within the organization, interaction with other institutions and organizations that participate in ensuring PS at hospitals, including problems related to its implementation at different hospitals.


patient safety, patient safety events, adverse events, management of patient safety events, comprehensive management model of patient safety events, Safety I concept and Safety II concept

Full Text:

PDF (Lithuanian)


An organization with a memory. 2000. Report of an expert group on learning from adverse events in the NHS. London: The Stationery Office. Prieiga internete http://www.aagbi.org/sites/default/files/An%20organisation%20with%20a%20memory.pdf [žiūrėta 2016-08-12].

Argyris, Chris. 1990. Overcoming Organizational Defenses. Facilitating organizational learning. Boston: Allyn and Bacon.

Baker, Ross, et al. The Canadian Adverse events Study: the incidence of adverse events among hospital patients in Canada. Canadian Medical Association Journal. 179,11 (2004): 1678‒1686.

Bitinas, Bronislavas., Rupšienė, Liudmila., Žydžiūnaitė, Vilma. Kokybinių tyrimų metodologija, Vilnius: Socialinių mokslų kolegija, 2008.

Braun,Virginia , Clarke, Victoria. Thematic analysis. In H. Cooper (Red.), APA Handbook of Research Methods in Psychology, 3, 2012

Brogienė, Daiva. Paciento teisės į kokybišką sveikatos priežiūros paslaugą ir žalos sveikatos atlyginimą. Daktaro disertacija.Vilnius:Vilniaus universitetas, 2010

Chan, Margaret. WHO Director-General foreword to the WHO Evaluation Practice Handbook. WHO Evaluation Practice Handbook. Prieiga internete: 2015 06 30. reliefweb.int/sites/reliefweb.int/files/resources/9789241548687_eng.pdf

Chesbrough, Henry. Open Innovation: A New Paradigm for Understanding Industrial Innovation. In H. W. Chesbrough, W. Vanhaverbeke, & J. West (Eds.). Open Innovation: Researching a New Paradigm, 21 (2006): 1-12. (2006a)

Chesbrough, Henry. Open Business Models: How to Thrive in the New Innovation Landscape. Boston, MA: Harvard Business School Press, 2006. (2006b)

Davie, Huw, Hutley, Tedd. Developing learning organizations in the new NHS. British Medical Journal, 320(1999): 998.

Davis, Peter., et al. Adverse events in New Zealand public hospitals: occurrence and impact. New Zealand Medical Journal . 115( 2002), 1167: 271.

Department of Health. Building a Safer NHS for Patients: Implementing an Organization with a Memory. London: DOH, 2002.

Donner, Allan. and Klar, Neil. Design and Analysis of Cluster Randomization Trials in Health Research. London, 2000.

Dunn, Marianne, et al. Expert panel method for nurse staffing and resource management. The Journal Of Nursing Administration, October, 25,10(1995): 61-67.

ECDPC (European Centre for Disease Prevention and Control). Healthcare-associated infections. Prieiga internete: http://ecdc.europa.eu/en/healthtopics/Healthcare-associated_infections/Pages/index.aspx. [žiūrėta 2016-08-15].

Ernst & Young Baltic, Paškevičius Laimutis. NĮ registravimo, stebėsenos ir prevencijos sistemos modelio parengimas ir aprašymas. Mokslo studija. Vilnius: UAB „Ernst & Young Baltic“, 2013.

European Commission. Patient Safety Making it Happen! Luxembourg Declaration on Patient Safety, 2005. Prieiga internete: http://ec.europa.eu/health/ph_overview/Documents/ev_20050405_rd01_en.pdf [žiūrėta 2016-08-10].

European Commission. Report from the Commission to the Council on the basis of member states' reports on the implementation of the Council Recommendation (2009/C 151/01) on patient safety, including the prevention and control of healthcare associated infections. Brussel. 2009.

Europos Komisija. Europos Komisijos ataskaita Tarybai. Parengta remiantis valstybių narių pateiktomis Tarybos rekomendacijos (2009/C151/01) Dėl pacientų saugos ir su sveikatos priežiūra susijusių infekcijų prevencijos ir kontrolės įgyvendinimo ataskaitomis. COM (2012) 658. 2012. Prieiga internete: 2013-12-19 https://ec.europa.eu/health/patient_safety/docs/council_2009_report_lt.pdf [žiūrėta 2016-08-12].

European Commission. Improving Patient Safety in Europe [web site]. 2016. Prieiga per internetą: http://ipse.univ-lyon1.fr. [žiūrėta 2015-02-01 ]

Giedrikaitė Reda. The evaluation of physicians' and patients' opinion on confidence and confidentiality. Medicina, 44,1, (2008).

Guest, Greg. Applied thematic analysis. Thousand Oaks, California: Sage, 2012.

Higienos institutas. Nepageidaujamų įvykių registravimo, stebėsenos ir prevencijos sistemos diegimas ir plėtra Lietuvos asmens sveikatos priežiūros įstaigose. Metodinis leidinys. Vilnius: Higienos institutas, 2015.

Hogan, Helen.,et al. Avoidability of hospital deaths and association with hospital-wide mortality ratios: retrospective case record review and regression analysis. BMJ,14, 351, (2015).

Hollnagel Erik. The Safety-I and Safety –II. The Past and Future of Safety Management. Ashgate, 2014.

Hong, Paul., et al. Evolving benchmarking practices: a review for research perspectives. Benchmarking: An International Journal, 19,4/5(2012): 444 - 462

ICES-CIEM.. Expert Group Reports, 2014. Prieiga internete: http://www.ices.dk/publications/our-publications/Pages/Expert-Group-Reports.aspx [žiūrėta 2016-08-11].

Yu Angela,et.al. Patient Safety 2030. London, UK: NIHR Imperial Patient Safety Translational Research Centre, 2016.

Kaiser Associates. Beating the competition: a practical guide to Benchmarking. Washington, DC: Kaiser Associates, 1988.

Kline, Peter . Ten Steps to a Learning Organization, 2015. Prieiga internete: http://www.amazon.com/Steps-Learning-Organization-text-Kline-B-Saunders/dp/B003PN4VJK [žiūrėta 2016-08-15]

Kohn, Linda., Corriggan, Janet. et al. To Err is Human: Building a Safer Health System. Washington, DC: National Academies Press,2000.

„Lietuvos Respublikos pacientų teisių ir žalos sveikatai atlyginimo įstatymas (Suvestinė 2015 m. redakcija)“. Prieiga internete: 2016 04 05. https://e-seimas.lrs.lt/portal/legalAct/lt/TAD/617017408f5b11e59c9a8f8c9980906b?positionInSearchResults=2&searchModelUUID=144e1cc2-ce5a-47a9-a48d-6d8c72e510fe pakeitimo įstatymas. Valstybės žinios. (2009), Nr. 145-6425. [žiūrėta 2016-08-16]

„Lietuvos Respublikos sveikatos apsaugos ministro įsakymas „Dėl LR sveikatos apsaugos ministro 2004m. rugsėjo 14d. įsakymo Nr.V-642 „Dėl sveikatos priežiūros kokybės užtikrinimo 2005-2010 m. programos patvirtinimo“ pakeitimo“ (2007). Prieiga internete: 2014-09-09. https://e-seimas.lrs.lt/portal/legalAct/lt/TAD/TAIS.242167/NMcjmUyGHe?positionInSearchResults=0&searchModelUUID=a3b7d617-5091-4dd5-9e73-00b931957f4e. [žiūrėta 2016-08-15]

„Lietuvos Respublikos sveikatos apsaugos ministro įsakymas dėl Lietuvos Respublikos sveikatos apsaugos ministro 2012 m. lapkričio 29 d. įsakymo Nr. V-1073 „Dėl asmens sveikatos priežiūros įstaigų, teikiančių stacionarines asmens sveikatos priežiūros paslaugas, vertinimo rodiklių sąrašų patvirtinimo“ pakeitimo. Valstybės žinios, V-92. (2015).

Marmienė, Loreta. Asmens sveikatos priežiūros specialistų požiūrio į pacientų saugą bendrojo pobūdžio ligoninėse vertinimas. Daktaro disertacija. Kaunas, 2015.

Metz,Julia.. The European Commission, Expert Groups, and the Policy Process, 2015 Prieiga internete: 2015-11-25. Prieiga internete http://www.palgrave.com/page/detail/The-European-Commission-Expert-Groups-and-the-Policy-Process/?sf1=barcode&st1=9781137437228 [žiūrėta 2016-08-15]

Panel discussion.Wikieducator, 2015. Prieiga internete: 2015-12-25. http://wikieducator.org/panel_discussion [žiūrėta 2016-08-14]

Paškevičius, Laimutis. Kompleksinio požiūrio į pacientų saugą ir rizikos valdymą sveikatos priežiūros organizacijose paieška. Sveikatos politika ir valdymas, 1,6, (2014): 133- 156.

Paškevičius Laimutis. Kompleksinis pacientų saugos įvykių valdymas Lietuvos ligoninėse. Daktaro disertacija. Vilnius: MRU, 2017, (spaudoje)

Reason James . Human error: models and management. BMJ, 320(2000): 768‒770.

Saldana, Johnny. The Coding Manual for Qualitative Researchers. Thousand Oaks, California: Sage, 2009.

Senge, Peter. The Fifth Discipline: The Art and Practice of the Learning Organization. New York : Doubleday, 1990.

Singh, Kavita. Learning organization and its impact on organizational effectiveness: a literature review. CLEAR International Journal of Research in Commerce & Management, 7, 6 (2016): 37-39.

Valintėlienė, Rolanda et al. Nepageidaujamų įvykių registravimo ir mokymosi sistemos diegimas Lietuvos bendrojo pobūdžio ligoninėse: esama padėtis ir poreikiai. Visuomenės sveikata, 1,68(2015): 40-45.

VASPVT. Asmens sveikatos priežiūros įstaigų veiklos kokybės vertinimo rodikliai (2013-2014),2014. Prieiga internete: 2014-02-06. http://www.vaspvt.gov.lt/node/493.

Vogel, L. Patient safety still lags a decade after seminal study. CMAJ: Canadian Medical Association Journal , 187,18(2015): 508.

World Alliance for Patient Safety. WHO Draft Guidelines for Adverse Event Reporting and Learning Systems. Geneva: World Health Organization (WHO/EIP/SPO/QPS/05.3), 2005.

World Health Organization. Data and statistics. WHO Regional office for Europa, 2016. Prieiga internete: 2015-10-10 . http://www.euro.who.int/en/health-topics/Health-systems/patient-safety/data-and-statistics [žiūrėta 2016-08-15].

DOI: http://dx.doi.org/10.13165/SPV-18-1-10-01

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM


  • There are currently no refbacks.

"Health Policy and Management" ISSN online 2029-9001 / ISSN print 2029-3569