Patient safety structures, processes and outcomes

Citation

Hurst, K. (2007), "Patient safety structures, processes and outcomes", International Journal of Health Care Quality Assurance, Vol. 20 No. 7. https://doi.org/10.1108/ijhcqa.2007.06220gaa.001

Patient safety structures, processes and outcomes

Patient safety – avoiding, preventing and ameliorating adverse outcomes or injuries stemming from healthcare processes (see Katz-Navon et al., and Hellings et al., in this issue for other definitions and examples) is gaining increasing importance and attracting more attention. Interest, no doubt, is driven by poor practice incidents, which led to disastrous consequences for patients and relatives; and inquiries concluding with confidence-sapping findings and far-reaching recommendations. Consequently, a flurry of manuscripts to IJHCQA in the last year, and coincidentally to our sister journal Clinical Governance, underlines the subject’s importance. The flurry prompted us to produce this special issue, which includes a range of fascinating and important material. For example, we are treated to:

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  clear and helpful discussion about patient safety’s international background and context;

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  broad and deep literature reviews;

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  patient safety’s theoretical underpinnings;

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  study methods and their challenges;

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  fascinating insights into what practitioners, managers and educators feel about patient safety’s nature and value; and most important

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  prevention strategies.

Braithwaite and his colleagues, in the first of two articles, describe a large Australian safety improvement programme. Professional attitudes towards multi-disciplinary education and teamwork seem to present special challenges. Mistrust between practitioners and non-clinicians, leading to under-reporting, whistle-blowing and scape-goating worries underline patient safety intricacies. I doubt if any of us underplay the complexities surrounding patient safety education – even though they are lacking in some undergraduate programmes – and practice. Doctors emerge as the most negative professionals and the hardest to please educationally and practically in the Braithwaite et al., studies. However, the authors offer valuable insights and recommendations that strengthen theory and practice – notably “identifying and correcting healthcare system vulnerabilities”. In their second article, the authors concentrate on methodological issues underpinning real-world, longitudinal patient-safety evaluations employing qualitative and quantitative data collection and analysis. Readers will not find many triangulation studies to this standard or magnitude. Finally, study limitations, honestly and clearly explained, will guide neophyte researchers working in the same domain.

Katz-Navon et al., write an unusual patient safety article oriented towards staff self-efficacy. First, they remind us about the problem’s extent; for example, almost 100,000 US patient deaths were attributable to treatment errors. Next, they use Bandura’s theoretical work to formulate several hypotheses about nurses’ patient-safety perceptions and actions; notably confidence and efficacy. Unlike Braithwaite et al.’s studies, managers emerge positively as safety mentors and guides. Although theoretically and methodologically detailed, the authors add considerably to good practice. Like Braithwaite et al., we are exposed to a methodologically detailed treatise from which readers can extrapolate to other contexts.

Similarly, Hellings et al., explore in detail some thinly-studied hospital safety culture perceptions. They attempt to connect patient safety structures, processes and outcomes (but admit that the latter evidence is thin). This weakness is easily off-set by their off-the-shelf patient safety culture questionnaire critique (notably the instruments’ psychometric properties). As in the Braithwaite et al.’s article, practitioners’ hospital manager perceptions are negative. The underlying fear and mistrust surrounding patient safety reporting and improvement systems is clearly an underlying theme in this special issue – one that all stakeholders must work hard to resolve if patients are to benefit. Hellings et al.’s brief between- and within-hospital patient safety culture benchmarks are a good starting place.

Labarere and Bosson’s patient-focused article concentrates on preventing deep-vein thrombosis (DVT) among at-risk patients (a common problem among patients manifesting one or more of the 15 risk factors carrying a high mortality rate). Their clinical guidelines and commentary drawn from routine data and literature-based evidence illustrate:

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  predisposing risk factors;

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  likely outcomes; and

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  most important a prevention strategy.

Elderly patients seem especially vulnerable; while other patients, conventionally thought to be DVT prone, were found to be low risk and vice-versa. A bonus in Labarere and Bosson’s article is the efficient and effective way the authors gathered data (they used observation) without recourse to amassing Bandolier type one evidence. Another bonus is their fascinating techniques for analysing and describing outcomes. Last but not least, Tavakoli et al.’s simple case study powerfully illustrates hospital safety. They describe a worrying and sobering operating theatre incident that had disastrous consequences for one patient and litigation costs for hospital staff. The authors show that iatrogenic illness caused by faulty equipment is more common than we realise. They also argue that international quality assurance standards may be insufficient for preventing these problems. Their recommendations (paraphrased elsewhere in this special issue) place every practitioner, manager, educator and researcher on guard.

Keith Hurst