The researchers concerned have looked at how errors are handled by the health service, and the relationship between such factors and efficiency improvements, routines and patient safety.
- This study found that safety attracts a low level of attention in the health service, and the organisations learn only limited lessons from mistakes, says Karina Aase.
A post-doctoral researcher in the department for media, cultural and social studies at the UiS, she has joined forces with Siri Wiig, Randi Thomassen, Espen Olsen and Sindre Høyland to investigate conditions at Stavanger University Hospital (SUS).
Aiming to draw conclusions about hospital safety in Norway, the study was based on a questionnaire which health personnel in every category and department were asked to complete anonymously.
They commented on such claims as “the priority given to patient safety is never reduced in order to get more work done” and “staff feel that mistakes are used against them”.
- We found little variation between different professions and departments, which was an interesting finding in itself, says Dr Aase.
She adds that 1 900 people participated in the study, which represents a 55 per cent response rate.
Under-reporting
One of the principal findings of the research is that health personnel substantially under-report errors. Reporting routines at the SUS require staff to report all types of non-conformances, including incidents which turned out well but could have gone badly.
No less than 45 per cent of respondents said that they have not reported a single undesirable incident over the preceding year. About 20 per cent reported one or two such incidents.
- Our research shows that all staff will be involved in undesirable incidents during a year, either personally or as a witness, says Dr Aase.
- So we can conclude with a high degree of certainty that under-reporting at Norwegian hospitals is considerable.
The actual reporting system was identified as one explanation for the failure to register errors. Staff feel they do not know how to use it, that training is inadequate and that the system is difficult to use.
- In the worst case, under-reporting could compromise patient safety, notes Dr Aase.
- Since the purpose of a reporting system is to learn from mistakes, staff should be over- rather than under-reporting.
Important
The questionnaire allowed staff to make their own comments about factors they regarded as important. Pressure of time, efficiency demands and lack of resources were mentioned most often.
- These factors are very relevant for safety, Dr Aase says. People often take short cuts when they’re busy. Safety is threatened if staff haven’t the time to talk to each other about episodes which could have gone wrong.
On the positive side, the study shows that few health personnel feel they are turned into scapegoats if they make a mistake. The research team regards this as a paradox in light of the under-reporting.
- But it’s positive for patient safety, since all treatment takes place in a collective, says Dr Aase, who believes openness is crucial for making patients safer in Norwegian hospitals.
- Health personnel must talk about mistakes, discuss the errors which have been made and come up with measures for avoiding a recurrence.
Management support
The UiS team also studied management support for patient safety, and found that the majority of respondents did not believe that senior executives facilitate a working environment which promotes this. That could reflect structural conditions, the researchers believe.
- A lack of focus on patient safety may be related to efficiency improvement processes and hospital reforms, suggests Dr Aase.
- Health sector reforms have concentrated greater attention on cost savings at Norwegian hospitals, and their managements must observe strict budgets.
- Management is an important source of safety culture. When it simultaneously signals the need to cut costs and increase patient throughput, staff could interpret this as downgrading patient safety.
Admits
Professor Stein Tore Nilsen, medical director at SUS’s department for research and human resources, admits that the priority given to patient safety is too low.
Nor is he surprised that the study found a high level of under-reporting and an inability to learn from mistakes at the hospital.
- We haven’t paid enough attention to patient safety. That’s why we’ve financed the research at the UiS to obtain a scientific documentation of conditions here.
- On the basis of this research, we’ll now be building up a good and long-term safety effort. We’ve spent too much time on firefighting. What we need now is a solid foundation.
The SUS will now establish a separate section for patient safety, but Prof Nilsen nevertheless emphasises that standards at the SUS and other Norwegian hospitals are generally good. He notes that most patients are satisfied with the service they get.
Measures
The UiS research team will devote the autumn to presenting their results, so that the SUS and other hospitals can develop measures to improve patient safety.
- One challenge facing Norwegian hospitals is a lack of resources, says Dr Aase.
- The fact that frame conditions threaten patient safety is an issue for the highest political levels.
However, she does not believe that safety will be increased simply by providing more money. It must also be entrenched locally in the various hospital teams and with each staff member in every department.
- The hospital management often talks about safety because they want to appear responsible, Dr Aase notes.
- If all safety initiatives come from the top, however, staff may feel that this is being forced on them in addition to all their other duties.
- Employees should therefore be able to influence the way they work with safety in their own jobs. A practical perspective, entrenched with each person and team, functions best.
Text: Ragnhild Thomsen
Photo: Elisabeth Tønnessen
