scholarly journals Patient safety, ethics and whistleblowing: a nursing response to the events at the Campbelltown and Camden Hospitals

2004 ◽  
Vol 28 (1) ◽  
pp. 13 ◽  
Author(s):  
Megan-Jane Johnstone
Keyword(s):  
Health Care ◽  
At Risk ◽  
Patient Safety ◽  
Quality Of Care ◽  
Code Of Ethics ◽  
Codes Of Ethics ◽  
Lessons Learned ◽  
Professional Conduct ◽  
Australian Health

IN NOVEMBER 2002, in what stands as one of the most significant whistle blowing cases in the history of the Australian health care system, four nurses went public with concerns they had about the management of clinical incidents and patient safety at two hospitals in Sydney, New South Wales. The handling of this case and its aftermath raises important moral questions concerning the nature of whistleblowing in health care domains and the possible implications for the patient safety and quality of care movement in Australia. This paper presents an overview of the case, the moral risks associated with whistleblowing, and some lessons learned. The International Council of Nurses (2000) Code of Ethics stipulates that nurses have a stringent responsibility to 'take appropriate action to safeguard individuals when their care is endangered by a co-worker or any other person'. Other local and international nursing codes of ethics and standards of professional conduct likewise obligate nurses to take appropriate action to safeguard individuals when placed at risk by the incompetent, unethical or illegal acts of others ? including the system. Despite these coded moral prescriptions for responsible and accountable professional conduct, taking appropriate action when others are placed at risk (including making reports to appropriate authorities) is never an easy task nor is it free of risk for nurses. As has been amply demonstrated in the literature, taking a moral stance to protect patient safety and quality of care can be extremely hazardous to nurses (Johnstone 1994, 2002, 2004; Ahern & McDonald 2002). In situations where nurses report their concerns to an appropriate authority but nothing is done to either investigate or validate their claims, nurses are faced with the ethical dilemma and 'choice' of whether to: do nothing ('put up and shut up'); leave their current place of employment (and possibly even the profession); or take the matter further ('blow the whistle') by reporting their concerns to an external authority that they perceive as having the power to do something about their concerns. It is rare for nurses to 'blow the whistle' in the public domain. When they do, it is usually because they perceive that something is terribly wrong and, as a matter of conscience, they cannot just look on as morally passive bystanders. For those nurses who do take a stand, the costs to them personally and professionally are almost always devastating, with no guarantees that the situation on which they have taken a public stance will be improved. Nurses who blow the whistle often end up with their careers and lives in tatters (see case studies in Johnstone 1994 & 2004).

scholarly journals Can the craze for patient safety hinder a more holistic care of the person in the health care system?

2018 ◽  
Vol 8 (12) ◽  
pp. 9
Author(s):  
Mamane Abdoulaye Samri ◽  
Daphney St-Germain
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Quality Of Care ◽  
Health System ◽  
Continuous Improvement ◽  
Clinical Governance ◽  
Decision Makers ◽  
Holistic Care

Background and objective: Since the publication of a report by the Institute of Medicine on the mortality associated with adverse events in the hospital, patient safety has become one of the essential objectives of the health care system. However, this movement tends to obscure the fundamental link between safety and quality of care in the health system. The study was aimed to demonstrate that the only focus on patient safety concept overshadow the more holistic care of the person and the population in the health care system.Methods: Documentary research in the Pubmed database and the Google Scholar search engine, from 1999 to 2017.Results and conclusion: Highly targeted safety research without addressing quality at first can only be a long-term panacea for current health policies. For cause, a one-way look at patient safety could lead to significant impacts at the population level. In order to get out of this craze, health system decision-makers would benefit from supporting clinical governance advocating humanistic and holistic strategies for interventions, engaging in a process of continuous improvement of the Quality of care more profitable in the long term. In order to overcome this craze, health system decision-makers would benefit from supporting clinical governance that advocates humanistic and holistic strategies for interventions, by engaging in a process of continuous improvement in the quality of care that is most beneficial in the long term. This posture is similar to Caring's well-known nursing model.

scholarly journals 6.H. Workshop: Quality strategies in European health systems: assessing their nature, use and effectiveness

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Cost Effectiveness ◽  
Health Systems ◽  
Health Care Quality ◽  
Care Quality ◽  
Lessons Learned ◽  
Potential Contribution ◽  
Policy Makers

Abstract Quality of care is one of the most frequently quoted principles of health policy, and is currently high up on the agenda of policy-makers at national, European, and international levels. However, the understanding of the term and what it encompasses varies. Many organizations and movements, such as evidence-based medicine, health technology assessment, provider accreditation, clinical practice guidelines and patient safety, play an important role in improving quality of health care. However, this broad field of quality-related initiatives is fragmented, and there is often a lack of awareness about parallel activities because of different labels. Evidence on the effectiveness and cost-effectiveness of different quality strategies is not always readily available for policy-makers, who have to struggle with prioritizing initiatives for investment. To provide a solid foundation for addressing these challenges, the European Observatory on Health Systems and Policies in collaboration with the OECD has put together a comprehensive study on health care quality, its interpretation and the evidence on different strategies aiming to assure or improve it. Drawing on this 2019 study, the workshop has the following objectives: Provide an understanding of the multidimensional concept of quality of care and its relation to health system performance as well as a comprehensive framework for looking at different strategies and their potential contribution to improving health care quality;Introduce key components of international and European governance for quality of care;Highlight the effectiveness, cost-effectiveness and implementation of selected quality strategies, with a focus on the European context:Health professional regulation, including education, licensing and registration, continuous professional development and mechanisms to ensure fitness to practice;External institutional strategies for health care organizations, including accreditation, certification and supervision;“Pay for Quality”, wherein financial incentives are paid to providers or professionals for achieving quality-related targets within a specific timeframe.Discuss and refine lessons learned through audience participation, and identify further areas for research and action. Key messages Quality of care is a political priority and an important contributor to population health. Within an overall strategic framework, understanding the potential of different quality strategies is key. Evidence on the (cost-)effectiveness of different quality strategies is variable but largely inconclu-sive. Maintaining an overview and identifying areas for action is paramount for policy-makers.

scholarly journals Why attitudes to quality of care are changing

2001 ◽  
Vol 24 (3) ◽  
pp. 5 ◽  
Author(s):  
Bob Gibberd
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Quality Of Care ◽  
Level Of Care

The editorial by Stephen Bolsin is appropriate at this time of change in attitudes to patient safety and qualityof health care. Bolsin has indicated one method to monitor the level of care; the recent use of comparative databy anaesthetic specialists. It is interesting to document the factors that have caused this change to collectingclinical indicators.

Creating a fractal-based quality management infrastructure

2014 ◽  
Vol 28 (4) ◽  
pp. 576-586 ◽  
Author(s):  
Peter J Pronovost ◽  
Jill A Marsteller
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Quality Of Care ◽  
Quality Management ◽  
Health System ◽  
Fractal Structure ◽  
Coordination Theory ◽  
Content Type ◽  
Fractal System

Purpose – The purpose of this paper is to describe how a fractal-based quality management infrastructure could benefit quality improvement (QI) and patient safety efforts in health care. Design/methodology/approach – The premise for this infrastructure comes from the QI work with health care professionals and organizations. The authors used the fractal structure system in a health system initiative, a statewide collaborative, and several countrywide efforts to improve quality of care. It is responsive to coordination theory and this infrastructure is responsive to coordination theory and repeats specific characteristics at every level of an organization, with vertical and horizontal connections among these levels to establish system-wide interdependence. Findings – The fractal system infrastructure helped a health system achieve 96 percent compliance on national core measures, and helped intensive care units across the USA, Spain, and England to reduce central line-associated bloodstream infections. Practical implications – The fractal system approach organizes workers around common goals, links all hospital levels and, supports peer learning and accountability, grounds solutions in local wisdom, and effectively uses available resources. Social implications – The fractal structure helps health care organizations meet their social and ethical obligations as learning organizations to provide the highest possible quality of care and safety for patients using their services. Originality/value – The concept of deliberately creating an infrastructure to manage QI and patient safety work and support organizational learning is new to health care. This paper clearly describes how to create a fractal infrastructure that can scale up or down to a department, hospital, health system, state, or country.

scholarly journals Clients' understanding of the role of nurse practitioners

2010 ◽  
Vol 34 (1) ◽  
pp. 59 ◽  
Author(s):  
Jane Allnutt ◽  
Nissa Allnutt ◽  
Rose McMaster ◽  
Jane O'Connell ◽  
Sandy Middleton ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Nurse Practitioners ◽  
Response Rate ◽  
Urban Setting ◽  
Successful Implementation ◽  
Positive Contribution ◽  
Australian Health

Nurse practitioners (NPs) have an emerging role in the Australian health care system. However, there remains a dearth of data about public understanding of the NP role. The aim of this study was to evaluate clients’ understanding of the role of the NP and their satisfaction with education received, quality of care and NP knowledge and skill. All authorised NPs working in a designated NP position in Western Australia and those working in three area health services in New South Wales were invited to recruit five consecutive clients to complete the self-administered survey. Thirty-two NPs (NP response rate 93%) recruited 129 clients (client response rate 90%). Two-thirds of clients (63%) were aware they were consulting an NP. The majority rated the following NP-related outcomes as ‘excellent’ or ‘very good’: education provided (89%); quality of care (95%); and knowledge and skill (93%). Less than half reported an understanding that NPs could prescribe medications (40.5%) or interpret X-rays (33.6%). Clients of NPs practising in a rural or remote setting were more likely than those in an urban setting to have previously consulted an NP (P = 0.005), and where applicable would to prefer to see an NP rather than a doctor (P = 0.022). Successful implementation and expansion of the NP role requires NP visibility in the community. Despite high levels of satisfaction, more awareness of the scope of the NP role is required. What is known about the topic?The role of nurse practitioners (NPs) in Australian health care is diverse and evolving. There is a dearth of research focusing on NPs, particularly looking at the client perception of their role. What does this paper add?This study investigates the client’s perception of the role of nurse practitioners and levels of confidence and satisfaction through the use of a self-administered questionnaire. What are the implications for practitioners?The results suggest that clients have a moderate awareness of the nurse practitioner role. Despite this, clients appear to have high levels of confidence and satisfaction after consultations with nurse practitioners. These results suggest that greater community awareness of the role may help maximise their positive contribution to health care in Australia.

scholarly journals Challenges Faced by Health Professionals in Obtaining Correct Medication Information in the Absence of a Shared Digital Medication List

Pharmacy ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 46
Author(s):  
Unn Sollid Manskow ◽  
Truls Tunby Kristiansen
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Quality Of Care ◽  
Health Professionals ◽  
Digital Systems ◽  
Medication List ◽  
Medication Information ◽  
Patient Medication ◽  
Ensure Patient Safety

Information about patient medication use is usually registered and stored in different digital systems, making it difficult to share information across health care organisations. The lack of digital systems able to share medication information poses a threat to patient safety and quality of care. We explored the experiences of health professionals with obtaining and exchanging information on patient medication lists in Norwegian primary health care within the context of current digital and non-digital solutions. We used a qualitative research design with semi-structured interviews, including general practitioners (n = 6), pharmacists (n = 3), nurses (n = 17) and medical doctors (n = 6) from six municipalities in Norway. Our findings revealed the following five challenges characterised by being cut off from information on patient medication lists in the current digital and non-digital solutions: ‘fragmentation of information systems’, ‘perceived risk of errors’, ‘excessive time use’, ‘dependency on others’ and ‘uncertainty’. The challenges were particularly related to patient transitions between levels of care. Our study shows an urgent need for digital solutions to ensure seamless, up-to-date information about patient medication lists in order to prevent medication-related problems. Future digital solutions for a shared medication list should address these challenges directly to ensure patient safety and quality of care.

Patient safety and quality of care: the role of the health care assistant

2004 ◽  
Vol 12 (6) ◽  
pp. 452-459 ◽  
Author(s):  
Hugh P. McKenna ◽  
Felicity Hasson ◽  
Sinead Keeney
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Quality Of Care ◽  
Health Care Assistant
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