Developing a functional patient safety framework for transitioning health services : a vision for quality management in a Jordanian acute care hospital

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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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