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The Institute of Medicine's seminal report, To err is human: Building a safer health system, established the national patient safety framework and initiated interest in…
The Institute of Medicine's seminal report, To err is human: Building a safer health system, established the national patient safety framework and initiated interest in changing the traditionally punitive healthcare culture. This paper reviews a multidisciplinary literature and offers an attribution framework to explicate the organizational processes that contribute to an industry-wide culture where clinicians are routinely blamed for adverse patient events. Attribution theory is concerned with the manner in which people explain the behaviors of others or themselves by assigning causality for events. To date, attribution theory, though well established in the management literature, has yet to be translated to healthcare. In this paper, we first describe the historical evolution of attribution theory in relation to human behavior in clinical practice and healthcare management and then discuss the work environments in contemporary healthcare organizations. Next, we demonstrate the applicability of attribution theory to healthcare by providing two adverse event exemplar cases. Then, the Healthcare Attribution Error Model is offered to demonstrate how concepts from attribution theory serve as antecedents to the employee cynicism, learned helplessness, organizational inertia, and the emerging Just Culture perspective. We conclude by suggesting attribution theory offers an important theoretical framework that warrants further conceptual development and empirical research. In the quest to produce exceptional healthcare environments where safety and quality are fundamental employee concerns, healthcare managers and clinical professionals need theoretically supported knowledge and evidence-based insights.
Through a number of comprehensive reviews, the Institute of Medicine (IOM) has recommended that healthcare organizations develop safety cultures to align delivery system…
Through a number of comprehensive reviews, the Institute of Medicine (IOM) has recommended that healthcare organizations develop safety cultures to align delivery system processes with the workforce requirements to improve patient outcomes. Until health systems can provide safer care environments, patients remain at risk for suboptimal care and adverse outcomes. Health science researchers have begun to explore how safety cultures might act as an essential system feature to improve organizational outcomes. Since safety cultures are established through modification in employee safety perspective and work behavior, human resource (HR) professionals need to contribute to this developing organizational domain. The IOM indicates individual employee behaviors cumulatively provide the primary antecedent for organizational safety and quality outcomes. Yet, many safety culture scholars indicate the concept is neither theoretically defined nor consistently applied and researched as the terms safety culture, safety climate, and safety attitude are interchangeably used to represent the same concept. As such, this paper examines the intersection of organizational culture and healthcare safety by analyzing the theoretical underpinnings of safety culture, exploring the constructs for measurement, and assessing the current state of safety culture research. Safety culture draws from the theoretical perspectives of sociology (represented by normal accident theory), organizational psychology (represented by high reliability theory), and human factors (represented by the aviation framework). By understanding not only the origins but also the empirical safety culture research and the associated intervention initiatives, healthcare professionals can design appropriate HR strategies to address the system characteristics that adversely affect patient outcomes. Increased emphasis on human resource management research is particularly important to the development of safety cultures. This paper contributes to the existing healthcare literature by providing the first comprehensive critical analysis of the theory, research, and practice that comprise contemporary safety culture science.
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…
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.
In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH) was signed into law. This Act, part of the broader “stimulus” legislation…
In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH) was signed into law. This Act, part of the broader “stimulus” legislation, represents the U.S.'s largest investment in health information technology (HIT) to date. More importantly, it sets a vision and provides a plan intended to transform the U.S. health care system to a safer, more efficient place to receive care. To that end, the Act seeks to fundamentally change the path HIT applications' adoption and implementation was taking to ensure that “meaningful use” and interoperability are achieved. However, such bold and sweeping changes will not come without unintended consequences, and their broad scope makes measuring the new public policy's success a challenge.
The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organizational prerequisite for the delivery of safe, reliable, and…
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.
Eric Williams and his colleagues review the literature on both physician burnout and physician–patient communication. A major contribution in this chapter is a model based…
Eric Williams and his colleagues review the literature on both physician burnout and physician–patient communication. A major contribution in this chapter is a model based on these two literatures, which outlines the impact that physician burnout can have on the physician–patient interaction and, therefore, patient outcomes. When physicians become emotionally exhausted, they begin to depersonalize to cope and focus on biomedical issues rather than communicating with the patient. When the patient is approached with this communication style from their physicians, they become less satisfied, trusting, and compliant. Less compliance results in worsened clinical outcomes, especially for patients with chronic disease. The authors discuss both the implications of this model and future directions for research.
The five articles in this section focus on topics such as pay-for-performance (P4P), high-commitment/high-involvement work practices, and safety culture. Interestingly…
The five articles in this section focus on topics such as pay-for-performance (P4P), high-commitment/high-involvement work practices, and safety culture. Interestingly, the link among all of these articles is in understanding and translating best practices in HRM from manufacturing organizations to health care organizations.