Essay: Improving patient safety and its relevance to health care

EXECUTIVE SUMMARY
This proposal is focused on the approaches for improving patient safety and its relevance to health care. It is of great importance that the safety of patients are considered a priority as they are the primary focus in healthcare sector. Patient safety approach is a worldwide priority and there is a current emphasis on improving patient safety culture to enhance safety of patients not just in Hospitals but in healthcare sector in general. The aim of this study is to identify and determine the effectiveness of patient safety culture approaches to improve hospital patient safety climate. This study includes both hand searched and electronic data that led to a conclusion. Some of the sites that was accessed electronically was PUBMED, SCIENCE DIRECT,PSYCHINFO, CINAHL, EMBASE, and PUBMED HEALTH, material of journals and reference list was searched manually. Relevant articles of inclusion criteria will also be considered in this study. English language studies published between 2009- 2019 that measured the effectiveness of patient safety culture approaches using a quantitative measure of patient safety climate in the settings of hospital.
In this work, there is a summary of the research literature related to approaches adopted to improve patient safety and the effectiveness of these approaches in hospital and healthcare settings. Evidence was reviewed to support the need of the study, research questions, conceptual framework and research methods. Key terms was also defined and the scope and limitations of the study was addressed.
1.0 INTRODUCTION AND BACKGROUND
Currently, there is a focus on measuring and improving patient safety culture to improve patient safety in hospitals and this is reflected in the growing number of literature reports on the performance in patient safety (Renata et al 2013). National health policy makers encourage patient safety at jurisdictional and even organisational levels with hospitals in many countries administering surveys. In the organisational culture, patient safety as a component entails the shared belief, attitudes, values, norms and behavioural characteristics displayed by the employees and influences and in fluences staff member attitudes and behaviours in relation to the organisation’s current patient safety performance (Palmeiri et al 2010). Since the institute of Medicine (IOM) report released in 1999 To Err Is Human: Building a Safer Health System, patient safety and quality has been part of the discussion in national health care. (Ulrich and Kear,2014).
There has been an estimate by the institute for Healthcare Improvement with an estimate of 40,000 errors occurring daily to harm patient patients with an average of 15 million mistakes that takes place on annual basis within the hospital setting (IOM, 2000). In response to the 1999 IOM report, organisations in healthcare began to device practices and approaches to reduce preventable harm to patients (Weingarten, 2013). Although in the past two decades patient safety has been a central and primary focus in practice and healthcare research, preventable errors continue to be a documented problem (Banihashemi et al, 2015; Groves & Semes, 2012).
Kohn et al (1999) reported an estimate of injury were 98,000 individuals die annually out of one million people because of medical error in the USA. A comparable report states that around 10% (approximately 850,000) of admissions in UK hospital were related with some form of patient safety incident, which could have or led to harm for one or more patients (Department of Health (DH) 2000). These occurrences cost the NHS approximately £2 billion in additional hospital days yearly, and avoidable suffering for patients and self-blame on the part of clinicians. In some countries, further studies submit these figures as being underestimated due to such incidents being under reported (Davis et al 2001, Baker et al 2004).
In 2015, Byrnes viewed patient safety as being in a state of crisis due to the frequent occurrence of patient harm events. Although initiatives in patient safety have been implemented in many health
care organisations, patients still faces an alarming rate from medical errors, which can result in debilitating injury or even death
(James, 2013; Markary & Daniel, 2016); Pronovost et al, 2009). Medical errors are still occurring despite these grave consequences and most of these mistakes are found to be preventable if the right approaches to patient care are adopted (Baniheshemi et al, 2015).
Factors such as poor communication, lack of nursing advocacy and even lack of team work have been noted as areas that have compromised patient safety (Choi Cheung & Pang,2014: Ulrich & Keaar, 2014). Renata et al in 2013, reported that despite the application of variety in patient safety approaches within hospital, there has been no prior systematic review of their effectiveness.
1.1 BACKGROUND
From the time of Hippocrates the dictum “ First do no harm” has nudged healthcare providers to deliver safe patient care. Many terms have been used to describe un intended injuries to patients in the process of delivering care, together with adverse events, medical errors, medical injuries, iatrogenic conditions, sentinel events, healthcare associated risks and hazards. While no standard definition of patient safety exists, Aspden et al in 2004 defined patient safety as the prevention of harm to patients. The impact of patient safety around the globe in healthcare cannot be overemphasised (Banihashemi et al, 2015; Chassin,2013).
A systematic review of 53 series of autopsies reported a median antemortem error rate of 23.5% (range, 4.1% to 49.8%) for major errors (clinically missed diagnoses involving a principal underlying disease or primary cause of death) and 9.0% (range, 0% to 20.7%) for incorrect diagnoses that are likely to have affected patient outcomes (Shojania et al 2003).
In 2018, World Health Organisation defined patient safety as “the prevention of errors and adverse effects to patient associated with healthcare
According to the Agency for Healthcare Research and Quality (2017), adverse events that are preventable occurs when the standard of care have not been met. Banihashemi et al in 2015, errors that can be prevented have led to serious safety events resulting in the death of patients.
Patient safety culture is a component of organisational culture that involves shared beliefs, attitudes, values norms and behavioural characteristics of employees and influences staff member attitude and behaviours in relation to their organisations ongoing patient performance( Palmieri et al 2010 ).
A number of patient safety questionnaires on approaches or strategies has been used within healthcare organisations to measure performance for yardstick, diagnosis and planning of internal quality improvement and in recent times have been used to examine the effectiveness of strategies designed to improve patient safety. Haynes et al in 2011 reported that positive patient safety approach has been reported to be associated with enhanced patient safety, Singer et al in 2012 consequently supported that aiming practice change through patient safety approach is considered to be a key tactic for solidification and enhancing of patient safety and outcomes in hospitals. Renata et al in their study in 2013 went further to support the work of Haynes et al by stating that it is important that interest to introduce approaches for improving patient safety is well-versed by producing of effectiveness.
There has been recent research focused on the establishment of a patient safety approach within the hospital system (Ulrich & Kear, 2014). Ammouri, Tailakh, Muliira, Geethakrishnan, Phil and Al Kindi in 2015, suggested that patient safety culture is related to teamwork and handoffs.
Feng et al in 2012 suggests that staffing levels and leadership are factors that have been associated with maintaining patient safety. In 2014, Alenius et al examined how the work environment correspond with nurses assessment of patient safety. Phelps and Barach in 2014 went further to state that an approach that can be effective in patient safety is the collaboration of stakeholders which includes the policymakers, consumers and clinicians.
Although, evidence based safety strategies have been adopted to reduce errors, serious mistakes still occurs ( Walker, 2018).
PROBLEMS AND JUSTIFICATION
2.0 PROBLEM STATEMENT
Patients are harmed daily in the hospital setting notwithstanding the amount of research that has been carried out on patient safety for the past two decades ( Makary & Daniel 2016). Approaches or strategies adopted by the hospital board seemed to yield minimal or less positive impact on patient safety. In exploring the concept of patient safety, it is of great importance to consider how hospital systems and processes, such as understaffed units, blaming cultures and a lack of patient safety practice lead to adverse events. Although previous studies have revealed the association between hospital systems such as hospital teaching status, ownership status, and even nurse staffing to patient outcomes (Thornlow 2010), few studies have sought to examine the approaches for improving patient safety as adopted by hospitals and if these approaches are effective.
Very little evidence indicates that the patient safety practices frequently used in other fields discuss any advantage on patient safety especially in acute care hospitals specifically on outcomes in patient safety. There is a growing concern that in spite of the avid and growing focus on patient safety and how to avoid adverse events in the hospital, small accomplishments have been made in this area. It was necessary to study the approaches that can be adopted by hospitals to reduce adverse events and promote patient safety. Putting into consideration on how the hospital staff especially the nurses perform tasks, and carry out specific roles in relation to the safety of patients.
Although researchers have described the utilization of patient safety in hospitals, this information has been based on methods focused on strategies such as surveys. This proposal may lead to the development of a theoretical framework addressing the hospital approaches for the improvement of patient safety and whether or not it is effective. This study filled the gap in the approaches the hospital adopt in order to ensure the safety of the patient.
2.1 JUSTIFICATION
Despite the awareness and emphasis on patient safety over the last two decades and given the increasingly complex nature of healthcare, it is being seen and reported that adverse events affecting the safety of the patients are still occurring in the hospitals, therefore the purpose of this proposal is to identify the approaches implemented by hospitals in relation to the improvement of patient safety and to determine if these approaches are effective or not. Through the analysis of focus interview group, a theory emerged that was grounded in the data obtained from the respondents to explain the relationship between the approaches or strategies the hospital implement and the safety of the patient.
3.0 NEED OF THE STUDY/SIGNIFICANCE
• The findings of this study will contribute greatly to the safety of patients in the hospital and healthcare sector at large.
• There is a need to identify more approaches the hospital team can adopt to increase and maintain positive safety of the patient.
• The results of the study will identify the approaches the hospital team implement that causes adverse events.
4.0 OBJECTIVES
The researcher in this study aims to
• Identify the strategies adopted by the hospital team that could promote safety of the patients.
• To access the effectiveness of the approaches implemented by the hospital team in promotion of patient safety
5.0 LITERATURE REVIEW
This heading presents literature search strategy, reviews the conceptual framework of the study and the relevant review of the literature related to the strategies adopted by hospitals in the promotion of patient safety and the effectiveness of these strategies. Despite thousands of publication on the topic patient safety, reviews reveals that little research has been carried out on the strategies hospitals adopt in relation to patient safety.
Nevertheless, some relevant findings to be drawn was summarised in this study. Relevant information gathered will be used in discussing the strategies hospitals implement in order to promote safety of the patient. Iterative literature search process was adopted by using the BPP University library databases. The databases used for this proposal include; PUBMED, SCIENCE DIRECT,PSYCHINFO, CINAHL, EMBASE, PUBMED HEALTH and PROQUEST. The search criteria filtered consisted of peer reviewed journal articles, dissertations, systematic reviews, books and quality report on patient safety. Google scholar was also used to search the literature for grounded theory methods and research related to patient safety. Multiple search on databases such as CINAHL and Medline `was conducted. Some of the terms used to provide a comprehensive review of the topic include: adverse events, medical errors, patient safety, sentinel events, serious safety events and hospital safety.
To further explore the literature, a second literature search was conducted using terms such as ; preventable harm, never events, near miss events, safety culture, evidenced based strategies and patient outcomes. Search limits consisted of peer reviews conducted within the last ten years due to limited articles on the topic.
Additional searches after reviewing reference list to see what existed on the topic was conducted between 2000 and 2018. Information on prominent patient safety websites such as Emergency Care Research Institute (ECRI), Agency for Healthcare Research and Quality (AHRQ) and the Joint Commission was also reviewed. These sites offered information on the root causes for errors, safety strategies to prevent errors and information on how to classify medical errors. The purpose of these sites is to support health care organisation to work positively on ways to improve safety of the patient.
Many patient safety incidents are related to lack of attention to human factors and ergonomics in the strategy and implementation of technologies, processes, workflows, jobs, teams and sociotechnical systems ( Carayon et al 2013).
Human factors is considered as a key discipline to help reduce or mitigate adverse events, to improve the strategies and implementation of health IT and to climate hazards that contribute to patient falls (Institute of Medicine, 2012).
These factors often referred to as ergonomics are those environmental, organisational and job factors which together with the individual’s characteristics, influence behaviour at work (McCaughan and Kaufman 2013). These factors include the individual and organisational perspectives and how the health and safety of people are affected. Human factors approach has been in place in the military and the aviation system as this plays a role in improving the performances of human and equipment designs. Nevertheless, in healthcare, there is room for improvement and more work to be done to establish systems to integrate work on device use, human error, team work and safety culture (McCaughan and Kaufman 2013).
The UK clinical Human Factors Group, which involves clinical human factors specialists was set up by Martin Bromiley following the death of his wife after surgery due to human factors.
In reviewing the evidence, greater attention has been given to safety of patients in the hospital and strategies to reduce the occurrence of adverse events. This study is focused on identifying the approaches adopted by the hospitals in order to improve the safety of the patient and also to access its effectiveness on patient safety.
Although numerous safety approaches have been implemented such as communication tools, safety checklist and even health information technology systems, it is been reported that adverse events that are preventable still occur in hospitals (Abramson et al, 2014; Makary &Daniel, 2016; McCann 2014; Zikhani,2016). The healthcare environment is very high and there is risk of occurrence of adverse events (Zikhani, 2016). Patient care is critical to healthcare quality and remains a developmental challenge in primary care in most countries (Verbekel et al 2014). According to Singer et al in 2009, Positive patient safety strategy is reported to be associated with enhanced patient safety and therefore focusing on practice change through patient safety strategy is considered to be of vital importance to reducing adverse events in the hospital.
Good management skill when adopted by the hospital board is considered to be an effective strategy in the promotion of patient safety. Managers who are invested in the wellbeing of their employees, health and safety as well and not just the delivery of care is reported to have reduction in the occurrence of adverse events. It is imperative to know that job satisfaction, organisational commitment, turnover intentions and physical and mental wellbeing of employees are predictors of basic outcomes in an organisation such as level of effectiveness, productivity and innovation and this means there are several reasons to encourage such positive employee attitudes by the manager.
In health care, it is important that the managers or leaders possess skills or attitudes that are not work oriented but also staff oriented as the attitudes of employees are likely to directly affect the quality of the patient experience (West & Dawson, 2011)
According to West et al (2015) in their King’s Fund publication, Management relates positively to supposed quality of care and staff satisfaction. It is also of great importance for the management skills adopted by Nurse Managers and not just the medical leaders to be of a positive leadership skill as Nurses are the primary care provider for patients. In 2008, Hamilton et al discovered in their study that in high performing trust hospitals, interviews constantly identified higher levels of both medical and Nursing engagement in administrative roles.
West et al (2015), in their work stated that Leaders or Managers that adopt leadership skills such as the Transformational or Authentic Leadership style tends to have a high percentage of positive patient safety as these leadership styles are characterised by leaders offering good models consistent with values and vision for healthcare, putting staff members into consideration, motivating and creating innovation among members of the staff.
Another strategy reported to bring about reduction in adverse events in hospitals is the importance of team work. Delivery of healthcare is usually in an extraordinary complex environment. In spite of highly skilled and dedicated clinicians, there are currently unacceptable high levels of communication failures which leads to occurrence of adverse events. In the promotion of patient safety, the relevance of effective teamwork cannot be overemphasised. Reliable processes of care in unification with effective teamwork is essential for the unswerving delivery of healthcare.
According to Leonard & Frankel (2011), Teamwork is an essential part of healthcare’s organisational fabric for the delivering of quality care. The further stressed that in the delivery of healthcare, team leadership is essential as it influences team dynamics. Historically, leadership is not taught in healthcare and as a result, finding effective team leadership in healthcare environments may be challenging ( Leonard & Frankel, 2011).
Bleakleay et al (2006) in their study reported on the effectiveness of team work amongst staff members and its positive impact on patient safety. In general, teams are defined as two or more individuals who work together to achieve specified and shared goals, have task‐specific competencies and specialized work roles, use shared resources, and communicate to coordinate and to adapt to change (Manser, 2009). In the process of providing healthcare it is required by physicians, nurses and other allied professionals from different specialties to come together and work as a team as it has been reported in most safety literature that team performance is crucial to providing safe patient care.
According to an article in the Guardian (2018), a huge majority of the NHS workers say they are worried about staff levels, according to a new survey findings that suggest a dangerous level of under-resourcing in the health service. Eighty percent of respondents which included nurses, doctors, and managers have raised concerns about there not being enough staff on duty to give patients safe and high quality of care ( Johnson,2018). More than one thousand NHS staff who belong to the Observer and Guardian’s healthcare network were surveyed. Almost half of respondents said care had been compromised on their last shift, while only 2% felt there were always enough people to provide safe care. More than 53% say they cannot provide the level of care they want to (Johnson, 2018). Good staffing system is considered as a strategy that promotes patient safety and reduces adverse events. Hall et al (2004) in their journal reports that the lower the proportion of professional nursing staff employed on a unit, the higher the number of medication errors and even wound infections. They went further and stated the importance of employing experienced professional in not just the Nursing field but in medical and Hospital sector at large, this is as a result of higher number of adverse events occurring due to under staffing and employment of less experienced staffs. There has been an increasing level of reports on the relationship between low staffing levels and adverse patient outcomes including an increase in mortality rates (Ball & Griffiths 2017).
According to an article in the Guardian (2018), a huge majority of the NHS workers say they are worried about staff levels, according to a new survey findings that suggest a dangerous level of under-resourcing in the health service. Eighty percent of respondents which included nurses, doctors, and managers have raised concerns about there not being enough staff on duty to give patients safe and high quality of care ( Johnson,2018). More than one thousand NHS staff who belong to the Observer and Guardian’s healthcare network were surveyed.