Document Type : Editorial


Medicine, Quran and Hadith Research Center & Department of Community Medicine, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran



Patient safety as a basic principle of quality is dominant in the global health agenda and mentioned as an essential requirement to organize a qualified health care system.1 In hospitals, the Director or chief executive officer (CEO) has the main responsibility for patient safety in the whole hospital, although all clinical leaders are responsible for patient safety within their ward. To clarify responsibilities and support clinical leaders in their work with patient safety, a formal structure is necessary. This formal structure may include a director of patient safety and patient safety officers in each large clinical unit. Moreover, a patient safety committee must be established to reviews all serious events and takes initiatives to improve clinical practice. Unfortunately, the main cause of medical errors in most cases are due to system weakness and therefore the Director and other clinical leaders have responsibility as other clinical staffs when medical errors happen.2

Based on WHO document, Patient safety officer (PSO) is a qualified senior staff member with responsibility and accountability for patient safety. PSO has to develop a schedule of audits, risk management program in order to identify, assess and reduce any adverse events, medication errors and other patient safety subjects. Also, PSO develop reports on different safety and risk activities and disseminate them internally and externally. Furthermore, PSO measures outcome of care to assess performance, with a special focus on patient safety and finally acts on results of audits, measures and feedback by implementing patient safety improvement projects.1

Two major outcomes of world patient safety movement due to Institute of Medicine’s 1999 report on patient safety, To Err Is Human, were 1) new guidelines that focus on requirements for documenting compliance with patient safety data and 2) a new responsibility for health care organizations to establish a “safety culture” based on the “science” of safety.3,4 Thus, PSO is an emerging role to fulfill these responsibilities. PSOs as managers of hospital’s patient safety programs, have a broad portfolio of tasks and responsibilities. These tasks range from reviewing patient charts in order to gather and present data that show compliance with formal regulations to the socially engaged task of planning and implementing programs so as to show improvement on safety targets. Thus, PSOs tasks lead to quality improvement due to data surveillance and reporting. Also, PSO role was defined as establishing connections within and between departments in the hospital. Usually, Most PSOs are nurses and this background help them to connect frontline staff to the hospital’s patient safety goals due to greater credibility with frontline staff and their supportive role between staff.4

Although PSO’s activities could lead to patient safety improvement and the quality consequently health care delivery; however, to achieve this success, there are serious challenges in this field such as high degree of mistrust and fear of reprisal on the frontline.4 To manage and overcome such challenging issues, the Director (CEO), PSOs and other staffs must create and establish a safety culture together to improve medical error reporting system and implement patient safety improvement projects.