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An adverse health event can affect women’s work capacity as they need time to recover. The institutional framework in the Netherlands provides employment protection during the first two years after the diagnosis. In this study, we have assessed the extent to which women’s employment is affected in the short- and long term by an adverse health event. We have used administrative Dutch data which follow women aged 25 to 55 years for four years after a medical diagnosis. We found that diagnosed women start leaving employment during the protection period and four years later they were about one percentage point less likely to be employed. Women in permanent employment did not reduce their employment during the protection period and reduced their employment with less than 0.5 percentage points thereafter. Furthermore, we found minor adjustments in the working hours in the short term and no adjustments in the long term. Lastly, we found that for wages, and not for employment and hours, adjustments could be related to the severity of the health condition: women diagnosed with temporary health conditions experienced a short-term wage penalty of about 0.5–1.7 percent and those diagnosed with chronic and incapacitating conditions experienced a long-term wage penalty of about 0.5 percent, while women diagnosed with some chronic and nonincapacitating conditions, such as respiratory conditions, experienced no wage changes in the short or long term.

Recent reports by the Institute of Medicine (IOM) signal a substantial yet unrealized deficit in patient safety innovation and improvement. With the aim of reducing this dilemma, we provide an introductory account of clinical error resulting from poorly designed systems by reviewing the relevant health care, management, psychology, and organizational accident sciences literature. First, we discuss the concept of health care error and describe two approaches to analyze error proliferation and causation. Next, by applying transdisciplinary evidence and knowledge to health care, we detail the attributes fundamental to constructing safer health care systems as embedded components within the complex adaptive environment. Then, the Health Care Error Proliferation Model explains the sequence of events typically leading to adverse outcomes, emphasizing the role that organizational and external cultures contribute to error identification, prevention, mitigation, and defense construction. Subsequently, we discuss the critical contribution health care leaders can make to address error as they strive to position their institution as a high reliability organization (HRO). Finally, we conclude that the future of patient safety depends on health care leaders adopting a system philosophy of error management, investigation, mitigation, and prevention. This change is accomplished when leaders apply the basic organizational accident and health care safety principles within their respective organizations.

This chapter proposes an optimized innovative information technology as a means for achieving operational functionalities of real-time portable electronic health records, system interoperability, longitudinal health-risks research cohort and surveillance of adverse events infrastructure, and clinical, genome regions – disease and interventional prevention infrastructure. In application to the Dod-VA (Department of Defense and Veteran's Administration) health information systems, the proposed modernization can be carried out as an “add-on” expansion (estimated at $288 million in constant dollars) or as a “stand-alone” innovative information technology system (estimated at $489.7 million), and either solution will prototype an infrastructure for nation-wide health information systems interoperability, portable real-time electronic health records (EHRs), adverse events surveillance, and interventional prevention based on targeted single nucleotide polymorphisms (SNPs) discovery.

The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organizational prerequisite for the delivery of safe, reliable, and cost-effective health services. However, HIT presents the proverbial double-edged sword in generating solutions to improve system performance while facilitating the genesis of novel iatrogenic problems. Incongruent organizational processes give rise to technological iatrogenesis or the unintended consequences to system integrity and the resulting organizational outcomes potentiated by incongruent organizational–technological interfaces. HIT is a disruptive innovation for health services organizations but remains an overlooked organizational development (OD) concern.

Recognizing the technology–organizational misalignments that result from HIT adoption is important for leaders seeking to eliminate sources of system instability. The Health Information Technology Iatrogenesis Model (HITIM) provides leaders with a conceptual framework from which to consider HIT as an instrument for organizational development. Complexity and Diffusion of Innovation theories support the framework that suggests each HIT adoption functions as a technological change agent. As such, leaders need to provide operational oversight to managers undertaking system change via HIT implementation. Traditional risk management tools, such as Failure Mode Effect Analysis and Root Cause Analysis, provide proactive pre- and post-implementation appraisals to verify system stability and to enhance system reliability. Reconsidering the use of these tools within the context of a new framework offers leaders guidance when adopting HIT to achieve performance improvement and better outcomes.

Adverse events in health care became more evident at the beginning of the 21st century, being an emerging problem worldwide and impacting the lives of people receiving health care, contributing to preventable injuries and deaths. This evidence has motivated the development of specific training in the area of patient safety with a strong focus on the education and training of health professionals, and, more recently, it also aimed at patient, informal caregiver and all citizens. In this sense, the use of digital technology for patient safety training has been an important challenge and proves to be a good solution for training and continuous learning, both for professionals and people in general. The use of multimedia, videos, games, simulators, among others, are effectively essential resources to improve people’s health literacy and safety of care.

This chapter presents a narrative review on patient safety training and the contributions of digital technology. The experience report will also be used, presenting some examples of quality improvement projects developed by Portuguese and Brazilian entities, in training contexts, highlighting the importance of investing in the health literacy of professionals, patients/informal caregivers and civil society, through applying specific techniques and using digital technology.

The voluntary hospital trustee has traditionally seen issues of medical care, including those of patient safety, as falling within the delegated sphere of the medical staff. This customary distancing of the trustee from direct involvement in patient safety issues is now challenged by unprecedented scrutiny of hospital safety results through voluntary disclosure or mandatory public reporting. This new climate, fostered by the Institute of Medicine's To Err is Human and the Institute for Healthcare Improvement's 100,000 Lives campaign, has complicated the role of the trustee in satisfying the traditional “prudent person” test for meeting fiduciary obligation as the trustee's breadth of involvement expands. Viewed theoretically, Mintzberg models the hospital as a case of a professional bureaucracy, in which the professional staff is responsible for standard setting and regulation. This traditional role of the professional staff is potentially assumed by others lacking technical background. Trustees are now asked to examine reports identifying physician compliance in attaining safety standards without education in the practice supporting those standards. Physician board members, whose numbers have increased in the past decade, are often sought to take the lead on interpretation of patient safety standards and results. The very public nature of patient safety reporting and its reflection on the reputation of the organization for which the trustee is ultimately accountable create a new level of tension and workload that challenges the dominant voluntary model of trusteeship in the United States health system.

In this chapter we explore some of the intriguing questions raised by contaminated communities. Is there a connection between exposure to environmental hazards and psychological distress? If yes, how best can it be measured? What kinds of psychological problems are aggravated by this kind of life stress? How do we know that victims are truly experiencing increased problems such as anxiety, depression and fears about their health?

The threat of future biological attacks within the United States forces the additional responsibility of preparedness and response onto health care managers. An endless amount of information on this topic can be readily obtained from a variety of sources. The purpose of this resource guide is to provide health care managers with a well-organized, up-to-date listing of credible sources that can be accessed electronically. This resource guide is designed to facilitate the retrieval of relevant information that is crucial in the process of health care managers designing a bioterrorism preparedness and response plan.

The implications of a bioterrorist attack within the United States were well observed in the 2001 anthrax attacks. The effects of these attacks were not only felt by the primary victims but also reached into communities and health care organizations that treated patients. The concerns for future attacks have spurred an enormous amount of interest and forced health care administrators to implement safety measures and develop plans encompassing preparedness and response. With respect to this topic, a major problem facing health care managers is the ability to obtain relevant, up-to-date, reliable information.

Many health care managers are aware of the endless amount of resources that are available pertaining to preparedness and response planning. It should also be noted that the information concerning bioterrorism rapidly changes and the available information can be overwhelming. To that end, the authors have compiled an array of selected websites that provide excellent, up-to-date, and unique resources in attempts to facilitate the gathering of knowledge and make that experience more efficient.

The objective of the following resource guide is to provide a comprehensive list of topics in a “user-friendly” format that can be obtained electronically. To facilitate information retrieval, electronic resources have been categorized according to topic. For example, up-to-date information concerning the multitude of biological agents can be obtained by using the links contained within the biological agents category. Under this topic heading you will find a listing of important resources. Each listing contains a heading that identifies the sponsoring organization, a short explanation of information and materials that can be expected, and a web address identifying its location.

The authors’ compilation was not intended to be exhaustive nor do the authors necessarily endorse or warrant the reliability of the information/products. Websites may change regularly; please visit www.bioterrorism@ba.ttu.edu to obtain an electronic version of this resource guide and for updates to web addresses.

Although competence to live alone is typically associated with measures of activities of daily living, such measures fail to capture problematic situations that older people face in daily life. In particular, little is known about how older homebound women handle potentially harmful incidents. During a descriptive phenomenological study of the experience of reaching help quickly (RHQ) with 40 older homebound women, 33 women spontaneously reported 139 incidents (falls, “tight spots,” near-falls, health problems, and unwanted visitors) that they managed alone. The purpose of this secondary phenomenological analysis of RHQ project data was to describe the experience of those women with handling “close-calls.” Data yielded a typology of close-call incidents and five components of the phenomenon, managing a close-call. In addition to self-directed intentions to lessen the impact of each incident, there were four component phenomena relative to help-seeking, ranging from no mention of need for help (70% of incidents) to managing without desired or solicited help (6% of incidents). Contextual factors, including availability of potential helpers and access to help-seeking devices, influenced intentions in close-calls. Findings are springboards for further research and stimuli for new approaches to practice. Researchers should broaden the focus of competence assessment to take in empirical situations. Further work should be done to explore how older people appraise their status following close-calls and how they move from self-management to consideration of help-seeking and in some cases, on to active help-seeking. Because few close-calls were reported, practitioners could use our typology as an assessment protocol during routine visits. Practitioners can elicit self-management intentions relative to a particular close-call and build dialogue around those intentions, thereby bolstering ability of older women to manage close-calls effectively.

In this chapter, we identify three distinct transformational performance improvement (TPI) approaches commonly used to redesign work processes in health care organizations. We describe the unique components or tools that each approach uses to improve the delivery of health services. We also summarize what is empirically known about the effectiveness of each TPI approach according to systematic reviews and recent studies published in the peer-reviewed literature. Based on examination of this research, we discuss what knowledge is still needed to strengthen the evidence for whole system transformation. This involves the use of conceptual frameworks to assess and guide implementation efforts, and facilitators and barriers to change as revealed in a recent evaluation of one major initiative, the Lean Enterprise Transformation (LET) at the Veterans Health Administration. The analysis suggests ways in which TPI facilitators can be developed and barriers reduced to improve the effectiveness and sustainability of quality initiatives. Finally, we discuss appropriate study designs to evaluate TPI interventions that may strengthen the evidence for their effectiveness in real world practice settings.