Developing a functional patient safety framework for transitioning health services : a vision for quality management in a Jordanian acute care hospital
- Publication Type:
- Thesis
- Issue Date:
- 2009
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The purpose of this study, conducted in a tertiary public hospital in Jordan, was to
identify and critically examine existing attributes that were seen to be problematic in
managing patient risk. The management of pressure ulcers (PUs) was chosen as a
representative exemplar to focus the research. A case study design using both
qualitative and quantitative methods was used to generate an in-depth account of safety
and quality issues. Data were analysed interpretatively and the findings used to develop
a proposed patient safety framework for patients in the acute care sector.
The main findings include an urgent need to begin the modification of the traditional
hierarchical bureaucracy within the organisation and the disciplines, towards structures
and processes that promote a multidisciplinary approach to patient care. Processes such
as the provision of multidisciplinary evidence-based practice guidelines to reduce
variation in practice standards, the implementation of multidisciplinary progress notes
in patients' medical records to prevent duplication inaccuracies and a team model of
nursing care are required and included in the proposed model. Improvements in the
organisational culture are likely to be achieved by engaging clinicians in organisational
decision-making structures and processes and providing them with performance
feedback by developing an incident monitoring system. The instability of the hospital
workforce makes the achievement of cultural change extremely difficult. Changes in
the employment of staff from one centralised government agency to a system that
enables managers to have more control of workforce employment in their organisations,
with staff themselves able to nominate where they work, are recommended.
Organisational managers also require more control in how funds are allocated to their
organisations to allow them to formulate budgets and identify funding priorities within
their organisations. The greatest impact on improvement will be achieved if reforms are
concurrently implemented.
A proposed framework incorporating these recommendations as a way to improve
patient safety in acute care has been developed for countries attempting health care
transition. The framework positions the patient as central to clinical care decisions and
clinical process management, and links the three key levels of the hospital together, i.e.
the clinical, organisational and ministry levels, as one interconnected activity. Such an
integrated framework will facilitate the concurrent implementation of the proposed new
structures and processes that research findings show are at the heart of patient safety.
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