Evaluation of the AHRQ patient safety initiative: synthesis of findings.

Stimulated in large part by the publication in January 2000 of the Institute of Medicine report, To Err Is Human: Building a Safer Health System, the U.S. Congress established patient safety as a national priority in FY 2001 and gave AHRQ the mandate to lead federal patient safety improvement activities. In a multifaceted approach, AHRQ funded projects to develop new knowledge on patient safety epidemiology and practices, developed infrastructure components to strengthen support for patient safety improvements, and pursued dissemination activities to encourage adoption of effective practices. To understand how the initiative was progressing, AHRQ contracted with RAND in September 2002 to serve as its Patient Safety Evaluation Center (evaluation center) and to perform a longitudinal, formative evaluation of the patient safety initiative. This 4-year evaluation, completed in September 2006, examined a broad range of components of the initiative. As described in the first article in this issue (Farley and Battles 2008), the evaluation design was based on the CIPP model, which encompasses the full spectrum of factors involved in the operation of a program (Stufflebeam et al. 1971; Stufflebeam, Madaus, and Kellaghan 2000), including the four evaluation components represented by the CIPP acronym: context, input, process, and product. Collectively, the articles in this issue address the CIPP evaluation components that we performed in evaluating the patient safety initiative. The context and input evaluations, which are summarized in the introductory article (Farley and Battles 2008), examined the strategic aspects of the initiative. The process evaluation focused on its more operational aspects. Examples of how our process evaluation assessed specific activities of the initiative are presented in the second through sixth articles (Sorbero et al. 2008; Taylor et al. 2008; Damberg et al. 2008; Teleki et al. 2008; Mendel et al. 2008) We examined many more such activities in the evaluation, with results reported in four evaluation reports (Farley et al. 2005, 2007a, b, 2008). The seventh article (Greenberg et al. 2008) summarizes our product evaluation analyses, which was developmental work to help AHRQ prepare for monitoring impacts of the initiative on various stakeholders. In this paper, we focus on process evaluation results, synthesizing our overall findings regarding AHRQ's progress in implementing its patient safety initiative over the 7-year period of 2000–2006. We also present suggested next steps for the initiative based on collective results from our context, input, process, and product evaluations. The purpose of a process evaluation is to assess the evolution of activities undertaken in a program, successes or failures in executing those activities, and factors contributing to its progress. The process evaluation serves an important role in its own right by providing information about which aspects of the program are working well and what changes are needed to improve aspects that are not as successful. In addition, process evaluation results can be used to help interpret program outcomes, to better understand the dynamics of the activities that led to either positive or negative outcomes (Rossi and Freeman 1993; Stufflebeam, Madaus, and Kellaghan 2000).