Introduction

An AI tool was used to translate this article from German.

At a time when the quality of healthcare is becoming more and more important, the topic of patient safety is becoming increasingly important.
We are pleased to present you today with an exclusive interview with PD Dr. med. Sven Staender, a pioneer in this field. Dr. Staender is a specialist in anesthesiology and intensive care medicine with over 30 years of professional experience, was chief physician at Männedorf Hospital for 25 years and founded the company Simply-Safe a year ago, which specializes in safety consulting in the healthcare sector. In his new role as a partner and advisory board member of new-win, he will work with us on the promotion and dissemination of the Critical Incident Reporting System (CIRS) in Switzerland with his proven expertise and professional advice.
As a renowned expert in patient safety and clinical risk management, Dr. Staender has made a significant contribution to the development of safety standards in the healthcare sector at home and abroad. In this interview, he shares with us his insights and visions for a safer future in the Swiss healthcare system.

The interview

Career and CIRS in Switzerland

Dr. Staender, thank you very much for taking the time for this interview. You have been working as a specialist in anesthesiology and intensive care medicine for over 30 years. They are considered pioneers in the field of patient safety and, together with Daniel Scheidegger and Mark Kaufmann at the University Hospital Basel, developed the Critical Incident Reporting Systems (CIRS) in 1995. Can you tell us something about your career and what made you decide to specialize in patient safety?

I had the privilege of working in Daniel Scheidegger’s team at the University Hospital in Basel. He was a visionary who looked “beyond the horizon” of anesthesia at an early stage and focused on quality and safety issues. Under him, Hans-Gerhard Schäfer developed the first team simulator in cooperation with the University of Austin (Texas) and established corresponding contacts with NASA and the then Swissair. It was in this environment that I came into contact with the topic and was convinced that we must not only rely on good technology and medicines in medicine, but must also take care of the human factor in these systems if we want to improve substantially. This means that we also have to fundamentally deal with human action and the consequences of it in complex systems. This was one of the basic ideas behind the development of CIRS.

Can you explain to us what the Critical Incident Reporting System (CIRS) is and how it is used in Swiss healthcare facilities?

CIRS is an anonymous reporting system for critical events in medicine. In other words, events that had a potential hazard, but for various reasons did not lead to a serious complication. Such events often have great learning potential and can also help to make processes safer.
The system was initially used primarily in anesthesia departments in hospitals, then increasingly in other specialist areas and finally often at the hospital level.

Can you give us specific examples of adverse events in healthcare facilities that can have serious consequences for patients and have been recorded by the CIRS? And how have these messages contributed to improving patient care?

There are many examples: potential mix-ups of medications with similar labeling, incorrect reprocessing of resuscitation bags, near-mix-ups of patients, etc.

How many of these adverse events are estimated to occur per year in Switzerland? Can you give us some statistical data?

This is not possible and also makes no sense: these reporting systems or the reporting of events is voluntary. And so we don’t know how many events are not reported. The motivation to report an event depends on many factors. So we will never know how many events actually happen. In addition, CIRS is a learning and improvement system and not a system for measuring risk. Voluntary reporting systems such as CIRS cannot quantify risk.

What do you think are the main reasons for the occurrence of avoidable errors in healthcare?

Safety in hospitals and healthcare facilities in Switzerland is under enormous pressure: on the one hand, there is the eternal question of resources and, on the other hand, the ever-growing demand of the population for health services and security. And all this in a system that is described as a complex system in terms of its organizational and process structure. This is a very dangerous mixture: complexity, scarcity of resources, pressure on efficiency and speed and high demands on success and security.

CIRS is mandatory in hospitals, and an approval criterion for new outpatient practices. How do you assess the implementation and use of the reporting system in the various health facilities and settings?

Without having a systematic overview here, I can say from my networks that CIRS unfortunately does not have the status it could and should have. Far too often, the system is used as a kind of alibi exercise, according to the motto: we have introduced CIRS and thus fulfilled our commitment to a risk tool. Of course, this is not the case: you can only learn from CIRS if you actively work with the cases, prepare them as learning cases, analyze them, give feedback and implement and communicate any improvement measures. So you have to work actively with CIRS.

Are all employees in a hospital obliged to report adverse events via the CIRS?

This depends on the degree of implementation in the respective hospital, i.e. whether it is a hospital-wide reporting system or department-specific. In addition, reporting to these reporting systems such as CIRS is voluntary.

Reporting adverse events is one thing. Analysing them and then deriving effective measures is another. How resolutely are the employees in hospitals acting here?

This also depends entirely on the resources. From a certain organizational size, a staff unit is needed to take care of the administration and coordination of the system. So here the first question arises: does this place exist? Furthermore, at all employee levels, working with CIRS cases must be considered quality work that is not done quickly after the end of the working day. So again: the active work with the cases from the reporting systems must be promoted by the organization, otherwise it degenerates into an alibi exercise.

Current developments

Reporting an adverse event means admitting a mistake. How has the error culture in the Swiss healthcare system developed in recent years? Can you give specific examples of progress or ongoing challenges in implementing a positive error culture in healthcare?

I’m not a fan of the term “error culture” because the term suggests too much susceptibility to error and very often people have connotations with it. We should rather talk about a culture of safety, learning or improvement. Because our employees do their best job every day and when something happens, we have to ask ourselves why it happened and what we can learn from it and possibly improve. We need to stop seeing people as a risk in complex systems, but as security. Without people who deviate from a regulation at certain moments, we can no longer cope with today’s complexity. But when something happens, we must not accuse and condemn, but ask ourselves what prompted these employees to act in this way. We have to understand the attempt to cope. Only then can we learn what we need to improve.

How do you assess the current situation of patient safety in Switzerland in an international comparison?

This is difficult to answer in such a general way, because the topic has so many different facets. In addition, there is no one parameter that could be measured on the subject of security and on the basis of which comparisons could be made with other countries. The OECD has made country comparisons on individual topics and in general one can conclude that we are in the good middle of the field in Switzerland.

In your opinion, what legal or political changes would be necessary to better anchor reporting systems in Switzerland?

The implementation of the Humbel motion is urgently needed. This motion was already introduced in the National Council in 2018 and in 2021 was finally referred to the Federal Council by the Council of States after the National Council. The aim of the motion is to establish confidentiality protection for such learning systems in Switzerland. As far as I know, the ball has been in the Federal Council’s court since then. In my view, an early implementation of this motion would be very desirable.

Self-employment and partnership with new-win

You started your own business last year and founded Simply-Safe GmbH. Can you tell us a bit more about it?

Throughout my professional life, I have always dealt with the topic of safety and risk. This always had to be reconciled with my professional work as a doctor. Now last year I decided to concentrate exclusively on the topic of risk and safety management and accordingly to give up my work in the hospital in favor of working for this topic. That’s why I founded Simply-Safe GmbH.

You are now also working closely with new-win. How did this partnership come about?

I have known Beat Fankhauser and his company for over 20 years. When I had just started as a chief physician in Männedorf in 1999, coming from Basel, I really wanted to achieve an electronic implementation of the CIRS system I helped develop. Beat Fankhauser was recommended to me and that’s how we came into contact back then. With my step into self-employment, it was therefore only logical to deepen this contact in the sense of closer cooperation.

What specific goals are you pursuing together with new-win in the area of patient safety and CIRS?

We want to use our mutual know-how by combining new-win’s knowledge and extensive experience in the field of software solutions with my knowledge of risk and safety management in medicine.

How do you think software solutions like new-win’s can help improve patient safety? To what extent does new-win support the technical development of CIRS in Switzerland?

As mentioned above, it is crucial that users of reporting systems are supported in the best possible way if they want to report or if they want to improve their organisation with incident reports. To do this, a software solution must be user-friendly and supportive. new-win’s solutions do both.

The future of CIRS

How do you see the role of digitization and new technologies such as artificial intelligence and big data in the future of CIRS and in terms of improving patient safety?

AI will enrich medicine, no question. The challenge will be to use these technical solutions wisely and sensibly: Is the database correct? Is the interpretation of the data correct or has an AI freely associated it, etc. We have to keep an eye on such questions. In addition, technical solutions can help to keep track of the endless flood of facts and knowledge in medicine.

What is your vision for the future of CIRS and patient safety in Switzerland and how does the cooperation with new-win fit into this vision?

At the macro level, we need to pay more attention to the issue of quality and safety in healthcare. The OECD recently calculated that about 13% of the direct costs in Western hospitals are due to problems in quality and safety. In addition to the ethical and moral challenge, we also have enormous economic optimization potential here, which must be tackled at all costs. At the organizational level, we need to streamline working conditions by reducing complexity and protect employees from decision-making conflicts between safety on the one hand and productivity in the broadest sense on the other. Good and targeted software solutions are crucial here.

And finally, the last question: What advice would you give to healthcare facilities looking to improve their safety culture?

Make the topic of “security” the core issue and invest in security. According to the OECD, costs fall when quality and safety are improved.

Final Words

Dr. Staender emphasizes at the end of our conversation: “Patient safety is a continuous journey, not a destination. It’s about creating a culture where safety is a top priority and every individual feels responsible for it. With CIRS, we have a powerful tool, but it’s up to all of us to use it effectively and learn from the findings.”
This conversation with Dr. Staender impressively shows how complex and important the topic of patient safety is. It becomes clear that it takes a combination of human expertise, cultural change and technological innovation to achieve sustainable improvements. The collaboration between experts like Dr. Staender and technology companies like new-win is a promising step towards safer healthcare for all patients in Switzerland and beyond.
We would like to thank Dr. Staender very much for this insightful conversation and look forward to our journey together.