Use of Systems-Theoretic Process Analysis to Design Safer Opioid Prescribing Processes

OCCUPATIONAL APPLICATIONS

A team of systems engineers, clinicians, and healthcare researchers evaluated the Systems-Theoretic Process Analysis (STPA) method to analyze and design a process to ensure safe opioid prescribing at an urban primary care clinic. The STPA framework of losses, hazards, and controls identified two major unacceptable losses, 10 hazards related to these losses, and 49 unsafe control actions. These analyses resulted in 16 suggested process improvements encompassing both technology and human elements. Although STPA captured the complex system of controls and feedback inherent in many healthcare processes, and shows strong potential to help redesign them, providers generally found the method to be somewhat overwhelming due to the time required, large amount of information generated, and divergence from traditional and simpler linear causality thinking. While the suggested process changes were direct and specific, stakeholders believe that some may be difficult to implement without significant upper-level management support.

Keywords:

• Opioid epidemic
• hazard analysis
• safety science

Acknowledgments

The authors thank Dr. Robert Edson for suggestions on earlier versions of this manuscript.

Conflict of Interest

Ms. Bargal, Mr. Eisner, and Ms. Jacobson have nothing to disclose. Dr. Atalay and Dr. Singer report grants from the Agency for Healthcare Research and Quality (AHRQ) during the conduct of this study. Dr. Benneyan reports grants from the National Institutes of Health, AHRQ, Veteran Health Administration, and National Science Foundation (NSF) during the conduct of this study.

Supplemental Material

Supplemental data [material/appendices] for this article can be accessed on the publisher’s website at http://10.1080/24725838.2018.1521887.

Additional information

Funding

This work was supported by NSF grant number IIP-1034990 and AHRQ grant number P30-HS-024453-01. The findings and conclusions are solely those of the authors; NSF and AHRQ were not involved in the design, writing, nor publishing of this paper.