Quality and Safety in Healthcare

Question 1

What are the dimensions of quality care?

Answer 1

1. safety - not harming people with care
2. effectivness - matching sicentific evidence to care
3. patient-centredness- patients in control of own care
4. timeliness - avoiding delays
5. efficiency - avoiding waste, duplicaiton
6. equity- justice in healthcare

Question 2

what is the definition of medical error?

Answer 2

the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim

-errors of commission or omission

Question 3

what are the risk factors for medical error?

Answer 3

• Age > 64 years
• increasing complexity of intervention
• severity of illness, intensity of care
• emergency department care - limited time
• duration of care - 6% increase per day in hospital

Question 4

What is the person centred approach of human error?

Answer 4

psychological precursors

• aberrant unsafe acts - inatention, forgetfulness, carelessness

people at the sharp end are blamed

• counter measures aimed at individuals - blame, litigation, disciplinary measures

treats errors as moral issues

• belief in a just world?

Question 5

What is the systems error approach to medical error?

Answer 5

human

organisational

technical constratins on performance

Question 6

What is the systemic error: James Reason for medical error?

Answer 6

system appraoch - errors to be expected, seen as consequences, cause in systemic facotrs

measures directed as systems, not individuals

systems, humans will always have weaknesses

Question 7

What are active failures? What are latent conditions?

Answer 7

Active Failures

• unsafe acts by people in contact with the system
• mistakes, fumbles, procedural violations
• direct effects, usually short -lived

latent conditions - ‘resident pathogens’

• error provoking
• create weaknesses
• can be found and remidied
• may be long-standing dormant features until combined with active failures to create error/accident

Question 8

compare the following approaches to medical errors : person vs. system

Answer 8

person

• emotionally satisfying to punish ‘bad people’
• legally convenient - isolates blame from system context
• errors seen as random
• less likely to admit to erros

System

• errors inevitable - sometimes best people make worst mistakes - do not lose best people
• may require organizational or systemic change - expensive
• error as pattern which can be prevented
• more likely to admit to error and learn from this