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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.

Adverse event monitoring is a problem‐oriented approach to clinical audit and health‐care quality improvement, which was developed and has been widely used in the USA. Briefly explores the technique itself and its evolution. Presents experience gained from the widespread use of the approach in a British acute hospital, and results from one specialty – ophthalmology. Suggests that the study of adverse events in patient care can produce significant improvements in patients’ care, that it is particularly suited to some specialties, and that it should be used alongside other techniques in hospital clinical audit programmes. Concludes that, as the demand for quality‐monitoring information from purchasers and within providers grows, adverse event monitoring may become one of the key techniques for quality assessment and improvement.

The aim of this study was to develop a multi‐professionally agreed list of adverse events, which may act as a prompt for clinical incident reporting in trauma and orthopaedics and to determine what healthcare professionals understand by the term adverse event. A modified Delphi process with healthcare professionals working in trauma and orthopaedics (242) in three NHS trusts was performed. The process involved initial brainstorming sessions, a two‐round Likert‐style postal questionnaire and final focus group discussion. The initial brainstorming sessions generated a list of 224 adverse events to be included in the first round of the postal questionnaire. They included 83 causes of adverse events, 36 health and safety related adverse events and 105 clinical adverse events. Following the second round questionnaire and focus group discussion, a final list of 20 adverse events was produced. There were variations between professional groups in terms of validity scoring of individual adverse events. Overall, medical staff gave a lower rating to the adverse events than the other two professional groups. There were also variations between professional groups in terms of response rates. The modified Delphi process proved to be a successful tool for generating a multi‐professionally agreed list of adverse events and for understanding what healthcare professionals understand by the term adverse event.

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 purpose of this article is to assess the reliability of an in‐depth analysis on causation, preventability, and disability by two separate review teams on five selected adverse events in acute hospitals: pressure ulcer, postoperative pulmonary embolism or deep vein thrombosis, postoperative sepsis, ventilator‐associated pneumonia and postoperative wound infection.

The analysis uses a retrospective medical record review of 1,515 patient records by two independent teams in eight acute Belgian hospitals for the year 2005. The Mann‐Whitney U‐test is used to identify significant differences between the two review teams regarding occurrence of adverse events as well as regarding the degree of causation, preventability, and disability of found adverse events.

Team 1 stated a high probability for health care management causation in 95.5 per cent of adverse events in contrast to 38.9 per cent by Team 2. Likewise, high preventability was considered in 83.1 per cent of cases by Team 1 versus 51.7 per cent by Team 2. Significant differences in degree of disability between the two teams were also found for pressure ulcers, postoperative pulmonary embolism or deep vein thrombosis and postoperative wound infection, but not for postoperative sepsis and ventilator‐associated pneumonia.

New insight on the degree of and reasons for the huge differences in adverse event evaluation is provided.

The purpose of this study is to explore the factors that influence the reporting of adverse events related to elder abuse and neglect in nursing homes from nursing home leaders' perspectives. Good leadership requires in-depth knowledge of the care and service provided and the ability to identify and address problems that can arise in clinical practice.

A qualitative explorative design with data triangulation was used. The sample consisted of 43 participants from two levels of nursing home leadership, representing six municipalities and 21 nursing homes in Norway. Focus group interviews were undertaken with 28 ward leaders and individual interviews with 15 nursing home directors. The constant comparative method was used for the analyses.

Both ward leaders and nursing home directors described formal and informal ways of obtaining information related to elder abuse and neglect. There were differences between their perceptions of the feasibility of obtaining formal reports about abuse in the nursing home. Three main categories of influencing factors emerged: (1) organisation structural factors, (2) cultural factors and (3) abuse severity factors. A main finding is that in its present form, the Norwegian adverse event reporting system is not designed to detect abuse and neglect.

This paper provides an in-depth understanding of patient safety and factors related to reporting elder abuse in nursing homes in Norway.

The aim of this review is to examine factors that may explain why other industries are considered ultrasafe while progress toward preventing adverse events in health care is not considered to have reached that level.

The paper is a narrative review.

Despite a decade of intense effort, the problem of patient harm in health care facilities remains a challenge. A recent study of ten hospitals in North Carolina, which have actively engaged in patient safety initiatives, reported rates of adverse events similar to those in the Institute of Medicine report, To Err Is Human in 1999. Seven key issues and their interaction are described.

This review focuses on broad issues that likely impede progress generally, not on individual project or individual hospital program success stories.

The authors believe the difficulty in making significant headway on the patient safety agenda is due in part to the fact that it was always going to be a long (indeed never ending) struggle – aviation for example took almost 60 years to become ultra‐safe – and in part to misunderstanding the nature of the dynamics that are involved in the generation of adverse events in risk critical industries. The paper reflects on the nature of the safety initiatives that health care has tended to focus on, but which have not sufficiently taken note of central concepts of safety science, as well as on features of the health care system itself that have impeded, in the authors' view, progress on enhancing patient safety.

The purpose of this paper is to draw attention to the problem of second victims involved in adverse events and their need for adequate support.

The impact on second victims involved in adverse events and implications for organisational support were determined from previous studies and relevant publications about this problem.

The impact of adverse events on health professionals who are involved in them can be profound. These second victims can suffer extreme emotional distress, anxiety regarding perceptions of their competence and professional isolation, and may endure long-term professional and personal consequences. Some of the more severe outcomes include leaving the profession, symptoms of post-traumatic stress disorder and suicide. Many studies report a substantial lack of organisational support for second victims. Key strategies have been recommended for organisations to implement to support second victims.

The authors note that recently published studies continue to report that organisational support is inadequate for second victims. Improved mechanisms of support would prevent the loss of second victims from the workforce, and ameliorate the severity and duration of the impact on second victims.

This paper aims to provide researchers and practitioners with an overview of how organisation behaviour research (OBR) helps to understand and resolve patient safety problems in health care.

The paper describes psychological, sociological and other social science theories and research which help to understand the causes of patient safety problems, how to implement change effectively and how to create an organisational culture of safety.

Social science perspectives and organisational behaviour research are beginning to show why improvements in patient safety are slow, and how to make lasting and effective change.

Social sciences and OBR have already helped make healthcare safer, but could make a greater contribution. Progress could be faster with greater awareness of the findings of this research and understanding of social science research paradigms.

Better implementation and safer care could result from providing implementers and decision makers with more knowledge and access to social science research. More useful social science research could be developed by research funders and proposal reviewers gaining a greater understanding of social science methods and potential, and by including this research in a field made up largely of traditional experimental medical research methods.

This paper provides an overview of the scientific and practical contributions of social sciences to patient safety and shows where future studies could assist understanding of current challenges and speed implementation of change.