Skill-based errors: What they are and how to avoid them

Question 1 

Skill-based errors occur when the task that the practitioner is engaged in is too familiar to the point that the practitioner may execute them like they are in auto-pilot mode. However, in performing such a task, the practitioner inadvertently does the wrong thing, fails to do the right thing, or mishandles the situation (Tallentire et al., 2015) . An organization can reduce the likelihood of the occurrence of such errors by insisting on the need for practitioners to always halt and think before acting on a task. 

Rule-based errors occur when a practitioner, though informed of the various rules in practice, uses the wrong rule in a particular scenario or misapplies the right rule (Tallentire et al., 2015) . Organizations can reduce such errors by training and coaching practitioners on the proper rules to use in various scenarios. 

Knowledge-based errors occur when a health practitioner lacks expertise in a particular field or when dealing with an unfamiliar situation (Tallentire et al., 2015) . In executing the task, the practitioner uses the familiar knowledge, trial, and error or takes guesses and, in doing so, results in an inappropriate action. The likelihood of such errors can be reduced by ensuring that practitioners are adequately trained and enacting policies that practitioners should engage experts in particular fields whenever they are faced with unfamiliar cases. 

Question 2 

The root cause analysis (RCA) and the failure modes and effects analysis are some of the tools recommended by the Joint Commission top ensure high quality and patient safety. The root cause analysis involves the assessment of reported incidents and identifying the prevailing errors (Hughes, 2008). The assessment acts as a basis for inputting policy and procedure changes. The RCA can ensure continuous quality improvement in scenarios where there is an observed trend of patients’ complaints after receiving treatment from a particular department. The RCA can unravel the underlying human errors. The failure modes and effects analysis (FMEA) involves conducting a risk assessment before the occurrence of events and helping identify probable areas of failure (Hughes, 2008). An example where FMEA can facilitate continuous quality improvement is when staff members are assessed on their expertise in a particular area, e.g., handling emergencies and receiving appropriate training after the identification of the inadequacies. 

Question 3 

Various social and economic factors affect the quality of health outcomes in communities. These include the level of education, employment status, income level (Swain, 2016). These factors are closely interrelated. Communities with persons with a high level of education are likely to hold formal jobs and receive decent salaries. Such individuals can afford high-quality health services leading to improvement in health outcomes. On the other hand, individuals in impoverished communities lack access to quality health services since they cannot afford them. 

Public health in low-income countries is riddled with issues such as unaccountability and lack of expertise. In line with the continuous quality initiatives, the WHO recommends five elements that may improve health care quality in such areas. These elements are, namely, adopting the evidence-based practice, embracing a participatory approach involving various stakeholders, ensuring accountability, engaging systems thinking, and innovative evaluation (Nambiar et al., 2016) . 

Question 4 

Microsystem refers to the system that is at the heart of healthcare provision and comprises units such as the health administrators, caregivers, and patients ( Likosky, 2014) . Patients and healthcare providers are the main players in the microsystem. The overall health of a community is influence by the interaction between these players through efforts such as patient education and patient compliance with health interventions. The macrosystem is comprised of the policymakers in the health sector who are predominantly government officials. The macrosystem is responsible for fixing health issues, e.g., through allocations to construct, equip, and operationalize health facilities. As such, this level affects the general health of the community by breeding health inequalities in society (McAllister et al., 2018) . Some members of the public may lack access to quality healthcare. Public health refers to the general health status of the members of the public in a specific location. The improvement of public health is dependent on the understanding that both systems are intertwined and should work in harmony. The policymakers who constitute the macrosystem ought to interactively engage health care providers in order to understand public health issues such as hygiene, socioeconomic status of the population, and quality of care. Such an understanding will help in crafting suitable policies that address public health needs. 

On the other hand, patients and health care providers are bound to adhere to the policies and regulations set by the policymakers. Often, policies are set with an aim to improve the health outcomes in a particular population. Such policies include a focus on hygiene, access to specialty care, access to medication, and healthcare providers. Policies dedicated to such areas would help improve the quality of public health. 

Question 5 

There will be an increased focus on quality improvement initiatives in the next 10 to 20 years amongst public health, nonprofit, and for-profit healthcare organizations. The quality improvement initiatives will focus on improving the patient health outcomes, health staff benefits, and the overall health of the general population. The focus on these areas will be influenced by the current pandemic, COVID-19, which has unveiled the different weaknesses in health systems (Institut Montaigne, 2020). The various health organizations will increase their spending on initiatives that will boost health outcomes. Notable initiatives will include improving the medical practitioners to patient ratios and bettering health infrastructure and facilities in hospitals. 

Public health, nonprofit, and for-profit health care organizations are likely to become becoming increasingly entwined in the future. The COVID-19 pandemic has revealed that decentralized efforts are disastrous in combating diseases ( Institut Montaigne, 2020 ). Consequently, public health, nonprofit, and for-profit health care organizations might engage in collaborative efforts such as in research to combat diseases. According to McClellan et al. (2019), the attainment of universal health coverage as envisioned by the United Nations is only possible through collaboration between the public and private health organizations. 

Question 6 

Healthcare systems strive to attain better patient outcomes, improve system performance, and enhance professional development. The attainment of these goals cannot be achieved through individual efforts. It requires the collective efforts of the various stakeholders involved in healthcare systems. Health care organizations can involve administrative professionals, clinical providers, and physicians in the following ways in order to attain this collective goal: 

Advocating for interprofessional collaboration amongst the clinical providers. Clinical collaboration amongst personnel from various clinical disciplines helps improve the patients’ health outcomes (Morley & Cashell, 2017). Thus, health organizations should foster a collaborative culture amongst the different health eams. 

Adopting coaching amongst clinical providers and physicians. Organizations can cultivate professional development amongst its staff by embracing a culture that encourages coaching amongst the health teams. The coaches who may also be termed as practice facilitators help facilitate training amongst clinicians and staff who may lack expertise in different fields (Agency for Healthcare Research and Quality (AHRQ), 2020) . 

Encouraging collaborative decision making amongst administrative professionals and other team players in the health setting (Babiker et al., 2014). The administrative professionals include the various heads of different units, e.g., human resources, finance, clinical departments, etc. Organizations should consider the views of the various administrative professionals before making crucial decisions since decisions made in a particular department affects the overall system performance. 

References 

Agency for Healthcare Research and Quality (AHRQ). (2020).  Section 4: Ways to Approach the Quality Improvement Process (continued) . Ahrq.gov. Retrieved 24 August 2020, from https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/4-approach-qi-process/sect4part2.html . 

Babiker, A., El Husseini, M., Al Nemri, A., Al Frayh, A., Al Juryyan, N., Faki, M. O., Assiri, A., Al Saadi, M., Shaikh, F., & Al Zamil, F. (2014). Health care professional development: Working as a team to improve patient care.  Sudanese journal of paediatrics ,  14 (2), 9–16. 

Hughes, R. (2008).  Tools and Strategies for Quality Improvement and Patient Safety . Ncbi.nlm.nih.gov. Retrieved 24 August 2020, from https://www.ncbi.nlm.nih.gov/books/NBK2682/ . 

Institut Montaigne. (2020).  How Covid-19 is Unveiling US Healthcare Weaknesses . Institut Montaigne. Retrieved 24 August 2020, from https://www.institutmontaigne.org/en/blog/how-covid-19-unveiling-us-healthcare-weaknesses . 

Likosky D. S. (2014). Clinical microsystems: a critical framework for crossing the quality chasm.  The journal of extra-corporeal technology ,  46 (1), 33–37. 

McAllister, A., Fritzell, S., Almroth, M., Harber-Aschan, L., Larsson, S., & Burström, B. (2018). How do macro-level structural determinants affect inequalities in mental health? – a systematic review of the literature.  International Journal For Equity In Health ,  17 (1). https://doi.org/10.1186/s12939-018-0879-9 

McClellan, M., Scherdel, L., Thoumi, A., & Udayakumar, K. (2019).  Achieving universal health coverage through value-based care and public-private collaboration . Brookings. Retrieved 24 August 2020, from https://www.brookings.edu/blog/future-development/2019/09/20/achieving-universal-health-coverage-through-value-based-care-and-public-private-collaboration/ . 

Morley, L., & Cashell, A. (2017). Collaboration in Health Care.  Journal Of Medical Imaging And Radiation Sciences ,  48 (2), 207-216. https://doi.org/10.1016/j.jmir.2017.02.071 

Nambiar, B., Hargreaves, D., Morroni, C., Heys, M., Crowe, S., & Pagel, C. et al. (2016).  Improving healthcare quality in resource-poor settings . Retrieved 24 August 2020, from http://dx.doi.org/10.2471/BLT.16.170803 . 

Swain, G. R. (2016). How does economic and social disadvantage affect health.  Focus ,  33 (1), 1-6. 

Tallentire, V., Smith, S., Skinner, J., & Cameron, H. (2015). Exploring patterns of error in acute care using framework analysis.  BMC Medical Education ,  15 (1). https://doi.org/10.1186/s12909-015-0285-6