فرهنگ سازمانی، عوامل بحرانی موفقیت، و کاهش خطاهای بیمارستان
|کد مقاله||سال انتشار||تعداد صفحات مقاله انگلیسی||ترجمه فارسی|
|4017||2007||25 صفحه PDF||سفارش دهید|
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Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : International Journal of Production Economics, Volume 106, Issue 2, April 2007, Pages 368–392
The problem of errors in patient care is a critical issue facing hospitals today. An Institute of Medicine [To err is human, building a safer health system. Washington DC: National Academy Press.] study estimates that medical errors are linked to more than 98,000 deaths annually, and that 58% of these error-related deaths are preventable. This paper investigates how organizational culture and specific management techniques (termed critical success factors (CSFs) in this paper) may lead to the reduction of medical errors in US hospitals. We draw on several different streams of literature, including medical safety, total quality management (TQM), and organizational culture, to develop a conceptual framework for the reduction of hospital errors. The results of a survey of more than 500 hospitals suggest that some characteristics of organizational culture are more likely to be associated with error reduction than other characteristics. In addition, the implementation of a set of CSFs is associated with error reduction as well. We conclude with implications and suggestions for future research.
US hospitals are becoming more accountable for reducing medical errors and improving patient safety. Two reports by the Institute of Medicine (IOM) published in 2000 and 2001 recommended that patient safety become a national priority (Institute of Medicine, 2000 and Institute of Medicine, 2001). The reports highlight the extent of the problem of errors in health care, explore the costs of these errors, and recommend improvements in health care delivery. The first report suggests that medical errors account for more than 98,000 deaths per year in US hospitals. The same study indicates that 58% of these error-related deaths may be preventable. These reports acknowledge that the necessary system improvements will require a “concerted effort” on the part of many individuals, from patients to policy-makers. In addition, in 2001, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO, 2001) introduced new patient safety standards that included a requirement that all unanticipated outcomes be disclosed. Prior research indicates that medical errors also negatively impact organizational performance. For instance, Tucker (2004) found that human errors or operational failures had significant financial implications to hospitals. Her study estimated that a 204-bed hospital with 75% occupancy could lose from $51,000 to $27 million to such failures. These estimates are based on an extensive study of nurse-related operational failures in hospitals. In this study, these total cost estimates are based on an observed rate of one failure every 74 min, seven patients per nurse, 24 h per day, and 365 days per year. The lower bound of this total cost range used the observed minimum cost of $0.33 per error, and the upper bound of this total cost range used the observed median cost of $177 per error. In addition, beyond the additional costs, errors contribute to customer dissatisfaction and overall reductions in quality of care (Tucker, 2004). As a result of not only the IOM reports but also internal and external pressures, hospitals across the country are developing error reduction systems to assist in reducing medical errors and adverse events. Hospitals are at various stages in the development and implementation of their programs and could benefit from a road map, or list of critical factors, needed for controlling and reducing medical errors. McFadden et al. (2004) developed a framework for reducing hospital errors and improving patient safety. The framework was based on the relevant medical literature, as well as a previously published aviation safety framework (McFadden and Towell, 1999). The authors used a case-study approach, interviewing directors of quality, performance improvement, and risk managers at four hospitals in Illinois, and identifying seven factors that are critical to the success of reducing hospital errors. A set of management techniques such as the aforementioned CSFs must be implemented within a specific organizational setting. One characteristic of an organization that is likely to affect the success of any management approach is its organizational culture (Schein, 1985). Moreover, organizational culture has been found to have a significant effect on the implementation of technology (McDermott and Stock, 1999; Lewis and Boyer, 2002) and total quality management (TQM) practices (Beer, 2003; Detert et al., 2000; Buch and Rivers, 2001). As we noted above, the problem of hospital errors has grown to one of critical importance and will likely require extensive changes in how hospitals are managed. Therefore, we expect that organizational culture plays a critical role in the success or failure of the reduction of medical errors in hospitals. This study collects data from a nationwide sample of professionals who work directly in the area of error reduction at hospitals throughout the US. One objective of the proposed study is to investigate the relationship between a hospital's organizational culture and specific outcomes related to hospital errors. In addition, the proposed study will examine whether implementation of the previously identified CSFs does in fact lead to the reduction of medical errors. Finally, we will consider whether organizational culture indirectly affects error reduction through a link to CSF implementation.
نتیجه گیری انگلیسی
To what extent have results been realized in each of these areas? • Quality improvement • Customer satisfaction increase • Net cost savings • Reduced frequency of errors • Reduction in the severity of errors • Increased understanding of errors • Heightened awareness of errors A.3. Quality management approaches To what extent can your quality program be described as each of the following quality systems? • Quality Control Circles • Total Quality Management • Baldrige Award System • Six Sigma System A.4. Organizational culture The organization is a very • Personal place—it is like an extended family. People seem to share a lot of themselves. • Dynamic and entrepreneurial place—people are willing to stick their necks out and take risks. • Results oriented—a major concern is with getting the job done. People are very competitive and achievement oriented. • Controlled and structured place—formal procedures generally govern what people do. The leadership in the organization is considered to exemplify • Mentoring, facilitating or nurturing. • Entrepreneurship, innovating, or risk taking. • A no-nonsense, aggressive, results-oriented focus. • Coordinating, organizing, or smooth-running efficiency. The management style in the organization is characterized by • Teamwork, consensus, and participation • Individual risk-taking, innovation, freedom, and uniqueness. • Hard-driving competitiveness, high demands, and achievement. • Security of employment, conformity, predictability, and stability in relationships. The glue that holds the organization together is • Loyalty and mutual trust—commitment to this organizational runs high. • Commitment to innovation and development—there is an emphasis on being on the cutting edge. • Emphasis on achievement and goal accomplishment—aggressiveness and winning are common themes. • Formal rules and policies—maintaining a smooth-running organization is important. The organization emphasizes • Human development—high trust, openness, and participation persist. • Acquiring new resources and creating new challenges—trying new things and prospecting for opportunities are valued. • Competitive actions and achievements—hitting stretch targets and winning in the marketplace are dominant. • Permanence and stability—efficiency, control and smooth operations are important. The organization defines success on the basis of • The development of human resources, teamwork, employee commitment, and concern for people. • Having the most unique or newest products. It is a product leader and innovator. • Winning in the marketplace and outpacing the competition—competitive market leadership is the key. • Efficiency—dependable delivery, smooth scheduling, and low-cost production are critical.