Author: Dr. Michael Weldi, Managing Director, Med-STA GmbH
A new Austrian primary care unit (Primärversorgungseinheit, PVE) opens. The premises are ready, the IT is installed and the rotas are in place. On the first morning, the telephone rings continuously and patients with very different needs fill the waiting area. Prescriptions, results, urgent cases, nursing queries, administration and internal coordination all need to work simultaneously.
This is when it becomes clear whether the unit has simply opened formally or is genuinely prepared to function as a care system.
The Austrian Patient Safety Award 2025 highlights this distinction. The primary care category recognised the project on Lean-supported commissioning with a High Reliability Organisation approach, “safety through structure”, undertaken by PVE Diakonissen Mürzzuschlag in collaboration with Med-STA.[1] The project title is technical, but its message is practical: patient safety begins with developing, testing and improving processes, roles, spaces, communication and emergency pathways before the first day of operation.
Why the launch phase is particularly sensitive
Primary care units are a central element of Austria’s health system. Their number is growing, and further expansion is an explicit health policy objective.[2][3] This creates new teams, organisational models, interfaces and care processes.
It is a significant opportunity, but establishment and commissioning also bring organisational vulnerability. Many people are working together in this particular team for the first time. Responsibilities are not yet familiar and routes through the building are new. IT, telephony, appointment systems, results management, medication processes and urgent care workflows need to be mastered in practice, as well as planned.
International patient safety literature identifies recurring risks in primary care: diagnostic delays, medication errors, communication problems, inadequate handovers, missed follow-up of results, and administrative and organisational errors.[4] These risks rarely arise from indifference. They often occur when committed teams work under time pressure with unclear processes.
Launching a primary care unit is therefore a clinical safety project as well as an administrative one.
Good intentions alone do not create patient safety
Healthcare teams want to work safely, but motivation, experience and individual care are insufficient on their own. Safety needs structures that support good work and make errors visible earlier.
The WHO Global Patient Safety Action Plan 2021–2030 emphasises patient safety as a systems responsibility.[5] Austria’s Patient Safety Strategy 3.0 seeks to foster learning, resilient organisations.[6] A primary care unit therefore needs a shared operating model, beyond expanding an individual practice to include more professions and longer opening hours.
This includes clear roles in routine and urgent situations, defined communication routes, traceable responsibility for results and callbacks, safe medication processes, agreed emergency and escalation pathways, workable interprofessional handovers and regular learning cycles after launch.
These details may seem straightforward until several demands arise together: an urgent patient contact, an incomplete result, a nursing query, a call from relatives, an IT problem and a team member who is unsure who should decide.
What the Austrian Patient Safety Award 2025 highlights
The Austrian Patient Safety Award is presented by Plattform Patient:innensicherheit and recognises projects intended to improve patient safety sustainably.[7] The recognised primary care project focuses on structured commissioning of a care unit, rather than a single training format.
The official description identifies Lean methods, simulation, interprofessional participation and an HRO approach, with improvements in process clarity, patient safety and staff satisfaction.[1]
This should not be turned into a general effectiveness claim extending beyond the documented project. An award is neither a randomised study nor a substitute for health services research. It provides a credible, award-winning practical example of preparing a primary care launch with safety in mind.
Other founders can learn from its central question without following exactly the same approach: which risks arise from our new spaces, roles, interfaces and workflows, and how can we test them before patients are affected?
Lean, HRO and simulation: three perspectives on the same launch
Lean, HRO and simulation are sometimes used too loosely in healthcare. They become useful when treated as practical tools.
Lean helps teams examine workflows from the perspective of patients and staff: where do waiting, missing information, duplicated journeys, unnecessary handovers or discontinuities between systems arise? In primary care, the aim is clearer, more stable and safer processes, rather than speed at any cost.
Our article explains how Lean and simulation can be combined systematically in hospitals: Lean in hospitals: why simulation is the missing component.
HRO stands for High Reliability Organisation. These organisations work in complex, high-risk environments and pay close attention to deviations, uncertainty and signs of error. Direct evidence for HRO implementation varies by setting, so the concept should not be oversold. Its underlying safety principles are useful: take weak signals seriously, clarify responsibility, draw on expertise and learn from near misses.[8][9]
Simulation makes planned workflows tangible. It reveals whether a process works under realistic conditions as well as on paper. in situ simulation — simulation in the actual working environment — is also used in the literature to identify latent safety threats: hidden system risks that might otherwise emerge only under pressure.[10][11]
This is particularly relevant before a new unit opens. An emergency bag may be present but badly located. An alerting pathway may be defined but unfamiliar to the team. A documented handover may still lose information in practice. A planned telephone triage system may struggle with high call volumes.
Five practical lessons for commissioning a primary care unit
1. Rehearse processes before opening
A process manual matters, but does not prove that a workflow functions. Before go-live, founders should test critical processes in practice: reception, urgent contacts, laboratory and results workflows, medication changes, home visits, telephone triage, interprofessional handovers and escalation when a patient deteriorates.
The aim is to understand honestly what happens when several demands arise at once.
2. Clarify roles explicitly, especially for exceptional situations
New teams often assume too much. Who makes decisions during a medical emergency? Who calls the ambulance service? Who stays with the patient, documents events or informs relatives? Who looks after other patients waiting?
These questions belong in preparation, before an emergency occurs. Interprofessional primary care teams benefit from explicitly agreed roles, responsibilities and decision pathways that they practise together.
3. Treat interfaces as potential risk points
Primary care safety depends heavily on transitions between doctors, nurses, practice assistants, social workers, therapists, external specialists, hospitals, ambulance services, laboratories and pharmacies.
WHO resources on safer primary care identify human factors, education, medication, diagnosis and transitions among the relevant safety areas.[12] Interfaces need clear ownership, feedback routes and follow-up.
4. Involve patients and families as partners in safety
Patients can contribute actively to safety when information is understandable, responsibilities clear and questions welcome. AHRQ describes patient and family engagement in primary care as an important component of safer medication processes, communication and follow-up.[13]
In practice, this means clear information about access, urgent care pathways, communication of results, medication lists and responsibilities. The less patients need to guess, the lower the risk of dangerous misunderstandings.
5. Plan for learning after opening
A safe launch does not end on opening day. The first weeks reveal which assumptions were realistic. Structured reviews, short feedback loops, ownership of improvement actions and a willingness to refine workflows are therefore essential.
Simulation literature shows that identifying latent safety threats is insufficient on its own. What matters is whether risks are documented, prioritised, addressed and followed up.[14] Founders need to act on what testing reveals. Otherwise, simulation remains an experience rather than a safety tool.
Implications for health policy
Expanding primary care in Austria involves how units begin operating as well as how many are established. If they are to be a pillar of healthcare, founders need organisational and safety support alongside legal, financial and building-related support.
Plattform Primärversorgung already provides important support through its founding handbook, PVE Accelerator and mentoring.[15][16][17] The Patient Safety Award 2025 adds a practical safety perspective: the critical period between planning and routine operations needs professional attention.
Quality starts during commissioning, before subsequent inspections. Funding, advice, mentoring and quality assurance should therefore consider whether new teams have realistically prepared their core processes, communication routes and emergency workflows.
How this relates to Med-STA’s work
Med-STA works at the intersection of patient safety, process improvement, simulation and the real working environment. “Train where you work” is relevant to primary care units because many risks arise through the interaction of space, people, equipment, communication and time pressure.
The PVE Startup-Paket applies this approach, helping teams address workflows, roles, interfaces and critical situations systematically before and during commissioning. In addition, SimLean360°, Consultancy & process improvement, structured emergency response training or simulation-based team training can help units test processes, rehearse emergency pathways or develop workflows already in operation.
Training alone does not make an organisation safe. It needs to connect preparation, realistic testing, debriefing, process adaptation and sustained implementation. Our article explores this in the context of emergencies in medical practices: Emergencies in medical practices: why preparation matters more than routine.
Conclusion: a safe launch is a leadership responsibility
Launching a primary care unit safely involves preparing a new care system so that patients, families and staff encounter processes that are as clear, stable and adaptable as possible from the outset.
The Austrian Patient Safety Award 2025 provides a practical Austrian example of treating commissioning as a patient safety project. It invites founders to identify critical processes, train together and improve systematically before problems occur.
For health policy, the message is equally clear: primary care expansion needs safe launches, alongside more locations.
References
- Plattform Patient:innensicherheit. Austrian Patient Safety Award 2025 – Gewinner:innen / Kategorie Primärversorgung. Projekt: „Lean-gestützter Inbetriebnahmeprozess mit HRO-Ansatz für Primärversorgungseinheiten – Sicherheit durch Struktur“, PVE Diakonissen Mürzzuschlag & Med-STA. [2025 winners, primary care category; project on Lean-supported commissioning with an HRO approach, safety through structure; German] plattformpatientensicherheit.at
- Plattform Primärversorgung. PVE Entwicklung in Österreich. [Development of primary care units in Austria; German] primaerversorgung.gv.at
- Plattform Primärversorgung. Planung von PVE. [Planning primary care units; German] primaerversorgung.gv.at
- Panesar SS, deSilva D, Carson-Stevens A, et al. How safe is primary care? A systematic review. BMJ Quality & Safety. 2016;25:544–553. doi:10.1136/bmjqs-2015-004178
- World Health Organization. Global Patient Safety Action Plan 2021–2030. WHO, 2021. who.int
- Bundesministerium für Soziales, Gesundheit, Pflege und Konsumentenschutz. Patient:innensicherheitsstrategie 3.0. [Patient Safety Strategy 3.0; German] sozialministerium.gv.at
- Plattform Patient:innensicherheit. Austrian Patient Safety Award 2025. plattformpatientensicherheit.at
- Agency for Healthcare Research and Quality / Patient Safety Network. High Reliability. psnet.ahrq.gov
- O’Leary D, et al. High reliability organizations in health care: scoping review. PLOS Global Public Health. doi:10.1371/journal.pgph.0006181
- Lounsbury O, et al. The use of healthcare simulation to identify and address latent safety threats: a scoping review. Frontiers in Health Services. 2025;5:1682629. doi:10.3389/frhs.2025.1682629
- The Joint Commission Journal on Quality and Patient Safety. Using In Situ Simulation to Identify Latent Safety Threats Prior to the Opening of a Novel Patient Care Space. 2025. jointcommissionjournal.com
- World Health Organization. Safer Primary Care. who.int
- Agency for Healthcare Research and Quality. Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families. ahrq.gov
- Advances in Simulation. Resolving latent safety threats. 2025. doi:10.1186/s41077-025-00401-y
- Plattform Primärversorgung. Besser starten: Der PVE-Accelerator. [The PVE Accelerator; German] primaerversorgung.gv.at
- Plattform Primärversorgung. Besser starten mit dem PVE-Mentoring. [PVE mentoring; German] primaerversorgung.gv.at
- Plattform Primärversorgung. 10 Schritte zur Gründung einer PVE. [Ten steps to establishing a primary care unit; German] primaerversorgung.gv.at