The quality of healthcare is determined by a number of factors including staffing levels in a hospital and the level of expertise of the personnel. The safety of the patient is reliant on the practices of the nurses and the doctors attending to him/her. The fundamental component affecting the quality of health care is the level of preparedness an institution is for day to day patient needs. Human error from the medical practitioners must be eliminated to ensure the shortest healing time and highest patient survival rates. Several error management strategies exist to tackle the issue of errors in the health sector.
It is common to find reports of medical errors leading to detrimental results in various hospitals. The errors are mostly attributed to human negligence but are rarely intentional. Findings from the Institute of Medicine show that 7,000 patients die each year in hospitals due to human error, while another 100,000 die because of complications caused by unforeseen drug reactions. The report shows that there is huge disparity among hospitals in providing hospital procedures for various conditions and special patient complications. Mortality rates increase the cost of service, and minimally invasive surgical procedures are preferred as they have potential to increase the length of stay. It is recommended that hospitals improve the quality of health services by striving for incremental changes with patient feedback given priority among the changes.
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Medical errors are diverse and exist across the health sector. These can include diagnostic errors that involve incorrect testing, failure of laboratory equipment or incorrect readings from laboratory results. A delay in delivery of treatment is a form of human error that may lead to deterioration of patient condition. Errors can also be caused by faulty medical equipment such as thermometers, and faulty supporting machines including X-ray scanners. In the prescription and the subsequently administration of drugs, there is a chance of misinterpretation of information from physician to physician thus leading to wrong prescription. The various errors are grouped into two classes, active errors which are said to involve humans directly, and latent errors which are caused by system failure. Research shows that about 19% of all medical errors are caused by laboratory related defects and thus mainly latent, while only 8% is caused by mistakes made by physicians.
Nursing error is a major contributor to medical errors since nurses are mostly interacting with patients. A study targeting both registered nurses and practitioner nurses found that nurse errors can be caused by eight main reasons: lack of attentiveness, lack of agency, inappropriate judgement, medical errors, lack of intervention on patient’s behalf, lack of prevention, mistaken order and documentation errors. It is determined that morals are adhered to if a nurse advocates for the patient’s best interest. An inappropriate judgment by a nurse is defined as lacking enough evaluation or having faulty logic. Good nursing care involves preventing patient complication through practicing safety and minimization of errors. Nurses ought to make enough documentation such as the medication time for patients. The nurse should chart procedures and prescriptions before administration.
The theory of error suggests that error is inherently present in human nature and the way to avoid its consequences is to alter the external conditions. One approach to human error involves identifying and blaming the fault in behavior of the forgetful individual. Another way is to identify the nature of human errors and instead focus on mitigating the factors causing them. Anticipating error is one way of dealing with it. Institutions that are sensitive to error such as hospitals and banks, often have several layers of eliminating risk due to error. A system can involve technological risk barrier such as an alarm, as well as human layer for extra protection and procedural control. As the occurrence of error involves the failure of all the layers of protection, it is rare for error to occur. In the medical field, the last layer of protection is often blamed. However, a wholistic audit of the entire system of layers can better prevent future recurrence.
Error management involves getting prepared for error well before actual operation. The health sector is posed with the challenge of managing errors across the various layers. The two dimensions of error management are limiting the chances of dangerous errors and making systems that are fault tolerant. Similar to the aviation industry, human accuracy in the medical field is critical. The medical practitioners ought to adopt a culture of perfection to reduce and manage errors. The nurses must make use of technology as reminders for the need to stay alert at all times. The organization and operation of activities should be dynamic and interactive, carried out in time, immune to major failure and also have capacity to serve at peak demands. The physiological and psychological status of health workers require analysis on a regular basis. As well, practitioners should desist from working under fatigue, or pressure to prevent flawed judgment.
There are several ways of managing errors in the medical field. The first one is creating a culture of safety throughout the institution. Second, the hospital should match the patient needs with the available capacity. Third, the institution should facilitate communication between staff and patient. Finally, safe medical use should be encouraged. These practices are related to the accomplishment of daily goals in delivering service to patients. Information should be availed to those who need to prevent errors. The reliance on memory should be minimized by using computerized memory and processing power. Additionally, the structures that are critical should be geared towards error-free operation and tasks standardized for easier comprehension. Also, the number of hand-offs should be kept low to ensure continuity of tasks.
The staffing processes must be streamlined to avoid and manage error. The number of inpatients and outpatients should match the staffing resource. The staff should be paid more to improve morale and mood, which increase communication and the teamwork synergy. Regular training for the staff members should be conducted to keep up to date with technology changes. The institution of health ought to adopt to technology and acquire the most recent equipment to improve on the quality of healthcare. Creating checks and balances in the exercise of duties and responsibilities provides a conducive environment for practicing. The methods and procedures in the institution need standardization which simplify processes. Collecting feedback from patients is another way of error management. The recommendations from patients are essential is identifying the weakness and improving. The data from patients may require confidentiality depending on the nature of questions asked.
Patient safety is the foremost indicator of quality of health care. The Critical Access Program initiated in 1997 is meant to ensure patient safety in the Medicare Coverage among rural patients. The program has incentives such as simple payment options that are meant to provide integrated health care delivery systems. The public has several channels for reporting on the quality of health systems. The hospital consumer assessment of healthcare and providers and systems (HCAHPS) is an example of a reporting systems available for the public. It is a survey instrument that is standardized to provide patients; perspective of health provision. The data targets Medicare and Medicaid programs.
The Centers for Medicare and Medicaid Services (CMS) conduct research under the Reporting Hospital Quality Data for Annual Payment Update program. Through the program, hospitals submit data related to certain common illness among recipients of Medicare and Medicaid programs. The report summarizes over 30 quality measure that is distributed to assist consumers make informed decisions. It is also meant to encourage hospitals and physicians to improve the quality of medical services. A 2% penalty is enforceable upon institutions who fail to meet the minimum reporting requirements.
The Joint Commission is the institution tasked with accrediting and certifying health care organizations in the United States. The institution is mandated with maintaining standards in health care through continuous improvement. A report titled Quality Check was released by the Joint Commission in 1996; containing the directory of accredited organization and performance reports. The performance results rates service provision in common treatments, provides background to accreditation decisions, and provides interpretation of guidelines. There is a health care rating organization call Healthgrades, listed on NASDAQ. Healthgrades provides performance data of the top 5% hospitals. The comparison considers mortality rates and complication rates in over 26 diagnosis and procedures.
The quality of health care and patient safety is crucial in the health sector. Causes of error such as human error may lead worsened health on the patient. Other errors related to faulty equipment can also distort the accuracy of a diagnosis. Medical laboratory tools thus require regular maintenance to avoid latent errors. In other cases, it is essential to incorporate error management strategies to reduce the severity and recurrence of error. Setting up standard safety procedures to be followed creates a conducive environment for eliminating error. Approaching error through a layered system makes the whole system error tolerant. The cost of health care is reduced when errors are avoided and safety measures followed. Damages arising from mistakes or equipment failure end up costing more to both the patient and institution of treatment
