Eliminating Medical Errors – Improving Quality


Although the US healthcare system is often regarded as exemplary in the world, it is rather cost-ineffective and characterized by a lack of equity. Medical error is one of the major factors that have an adverse impact on American health care. Makary and Daniel (2016) note that medical error is the third leading cause of death in the country. Medical error reporting is seen as an effective solution to the problem that can reduce the costs and the rate of medical error in US health care. Makary and Daniel (2016) claim that the lack of a comprehensive reporting system is one of the primary reasons for such high rates of medical errors.

However, the development of such systems and their effective implementation is associated with various challenges. For instance, nursing practitioners are reluctant to report due to workload, their fears regarding possible negative reactions of their supervisors, and fears of certain adverse effects on the job (Dyab, Elkalmi, Bux, & Jamshed, 2018). This paper includes a brief description and the analysis of an intervention aimed at introducing a sound reporting system in a healthcare facility.

Literature Review

Medical error is one of the major concerns of researchers and practitioners that makes them look into various aspects of the problem. Apart from the loss of human lives, which is a burden for families, communities, and the nation, these deficiencies are associated with considerable financial losses. It has been estimated that preventable medical errors that caused the injury are between $17 and $29 billion in total national costs (To err is human, 2000). The prevention of medical error is regarded as one of the elements of patient safety (Kim, Lyder, McNeese-Smith, Leach, & Needleman, 2015). Kim et al. (2015) also note that the collaboration of healthcare professionals is another element of patient safety as well as an effective strategy to prevent medical errors.

As mentioned above, medical error reporting is regarded as a potential solution to the problem or, at least, a strategy that can contribute to the substantial decrease in medical error rates (To err is human, 2000). Dyab et al. (2018) explore the obstacles to the successful implementation of a reporting system and state that these are healthcare practitioners’ workload and their fears as to their working environment, adverse influence on the job, and supervisors’ reactions. Hwang and Park (2017) examine the relationship between nursing professionals’ systems thinking, medical reporting, and adverse effects rate.

The researchers note that nurses displaying higher systems thinking competence are more likely to report errors and focus on patient safety (Hwang & Park, 2017). It is possible to note that medical error reporting has been utilized and associated with positive outcomes, so the implementation of an intervention that involves this tool can be beneficial.

Theoretical Frameworks

Prior to the discussion of the intervention, it is necessary to outline the theoretical framework that will guide this project’s implementation and evaluation. First, the basic provisions of the normal accident theory will be employed as the intervention is closely linked to the concepts of system and error. The occurrence of medical errors can be considered in terms of this theoretical paradigm. According to this theory, systems are associated with errors due to their complexity as well as people’s cognitive peculiarities (Dekker, 2016). On the one hand, different elements of the system may overlap or disrupt the functioning of each other, which inevitably leads to flaws and errors.

On the other hand, people’s cognitive abilities are also associated with certain limits as people’s memory may weaken due to overload, fatigue, illness, and other reasons. In simple terms, people are bound to make mistakes, especially when they have to deal with multiple issues and tasks. The suggested intervention will be based on the assumption that errors are an indispensable part of the healthcare system, but many of them can be prevented.

Another theory used to frame this program is the community of learning theory. A community of learning can be referred to as the environment that is favorable for the effective learning of people who have shared values or interests (Sarr, 2017). Sarr (2017) notes that communities of learning consist of three elements: learning space design, information exchange, and curricular design for learning. Learning space design is associated with the development of a proper environment for learning, including specific areas and schedules.

In the clinical setting, regular meetings and workshops can be seen as learning spaces. Information exchange involves a variety of activities aimed at sharing information and acquiring knowledge and skills. Healthcare practitioners complete various tasks during training sessions and discuss different topics during meetings or informal communication. Curricular design of learning includes educators’ effort to plan activities aimed at facilitating discussion and learning (Sarr, 2017). This component can be related to the organizational culture and administrative involvement in the process of learning.

The inability of healthcare facilities to create learning organizations’ culture is linked to their inability to manage properly one of them (or several) elements of the community of learning. At that, the creation of communities of learnings is pivotal for the reduction of medical error in the healthcare setting. Reporting is an important constituent part of learning community establishment as it facilitates information exchange. The suggested intervention will be based on the principles of an effective community of learning and will include all three components.

Finally, a motivational theory will also be utilized to ensure the successful implementation and evaluation of the project under analysis. Maslow’s hierarchy of needs will be used to address the concept of motivation. This theory holds that people’s motivation is closely related to such people’s needs as psychological, safety, belonging, esteem, and self-actualization (Braungart, Braungart, & Gramet, 2017). It is essential to make sure that an intervention will be positively viewed and that the participants will remain committed to its goals. Otherwise, no change can occur due to people’s resistance, misunderstanding of the goals, or passiveness.

The prevalence of medical errors in the US healthcare system is closely linked to people’s inability to create a setting where healthcare professionals’ needs could be met. The review of people’s needs can help in facilitating nurses’ motivation and the development of an effective intervention that will reduce the rate of medical errors.

Project Implementation

The proposed intervention will involve the use of technology and regular meetings of the nursing staff. The participants will be encouraged to report near-miss events and medical errors they witnessed or caused. The reporting will be anonymous, which will enhance nurses’ motivation to tell about errors as they will not be afraid of negative outcomes described by Dyab et al. (2018). This anonymity is consistent with the theory of human needs as the participants will have a sense of belonging and self-actualization due to their contribution to the improvement of the system. The nurses’ self-esteem will also be high as they do not have to accept that they were the ones who made a mistake.

The reporting process will be implemented with the help of the information system used at the facility. The participants will complete a specific form where they will describe the error as well as its potential or actual outcomes. A nursing leader will analyze the reports and come up with a set of topics to discuss during a session. The training sessions will take place on a weekly basis. The participants will discuss specific errors, their occurrence, possible outcomes, and ways to avoid them.

If necessary, workshops aimed at the development of particular skills will be held. Apart from discussing medical errors, the participants will be involved in the process of policies and standards creation and establishment. Their needs of belonging and self-actualization will be met once the community of learning emerges. The nursing professionals who will take part in the intervention will share knowledge and try to establish standards that will improve the system.

It is necessary to note that the nurses of one department will participate in the discussions and the process of policy development. The primary goal of these regulations will be preventing medical errors and improving patient safety. The designed standards will be applied in this department exclusively, at least, until the policies are evaluated. The guidelines that will prove to be effective will be transformed into the standards for the entire medical staff of the healthcare facility.

Intervention Evaluation

In order to evaluate the effectiveness of the intervention, it is essential to examine several aspects. First, it is necessary to identify the relationship (if any) between the intervention and the medical error rate. It is anticipated that the rate of medical error occurrence will decrease three months after the start of the intervention. This measurement will be analyzed with the help of quantitative tools. Medical error rates before the start and the rates three months after the beginning of the project will be compared. In this way, it will be possible to estimate whether the primary goal of the program has been achieved.

Furthermore, it is essential to examine the participants’ perspectives concerning the intervention, its design, and outcomes, as well as medical errors and reporting in general. Questionnaires are an appropriate evaluation instrument in this case as it enables the researcher to analyze the attitudes of a larger sample as compared to interviews. The participants will respond to Likert scale questions that will address such areas as the attitude towards medical error and reporting and their overall satisfaction with the implemented activities.

Nursing professionals will also reveal their concerns and fears and the level of compliance with the introduced guidelines and standards. Finally, focus group discussions can be instrumental in developing a larger-scale intervention that could be utilized in other departments. During these discussions, the participants will share their views on the central challenges associated with the intervention and the way these obstacles can be addressed.

Evaluation of Research Tools

The process of evaluation is not confined to using certain measurements; it is essential to evaluate the utilized instruments in order to make sure that the tools are appropriate and relevant. Reliability and validity concepts are often used when evaluating research methods (Grove, Gray, & Burns, 2014). For instance, the validity of research measurements ensures that the right variables are analyzed while reliability is concerned with the tools’ consistency (Heale & Twycross, 2015). It is critical to make sure that valid and reliable tools have been used to evaluate interventions.

As far as the suggested project is concerned, the employed evaluation tools are valid and reliable. For example, the use of such quantitative methods as the calculation of the rate of certain events occur is common in nursing (Grove et al., 2014). As mentioned above, the major goal of the intervention is to reduce medical error rates, so it is but natural that this measurement will be evaluated. The comparison of the rates before and after the implementation of the intervention will unveil specific quantitative outcomes.

Questionnaires are common tools to evaluate people’s attitudes and perspectives. As mentioned above, this instrument enables the researcher to obtain a considerable bulk of evidence within quite a short period of time, which makes this method cost-effective. As for its validity and reliability, Likert scale questions are employed in many studies and have proved to be effective when identifying people’s attitudes (Grove et al., 2014). Furthermore, the reliability of this tool can be double-checked with the help of an internal consistency assessment that implies the identification of the correlation between different items of the questionnaire.

Focus group discussions are quite common in qualitative research, but they are often associated with some limitations. For instance, Grove et al. (2014) note that this instrument can be characterized by a considerable degree of bias due to people’s concerns to be misunderstood or criticized. However, in this case, the participants will not reveal their attitudes towards some sensitive issues such as medical errors and their (or their peers’) performance.

The nurses will discuss the effectiveness of the intervention and its impact on the system, existing policies, and guidelines. The value of this measurement should not be underestimated as it involves the interaction of people sharing certain views who put to the fore different aspects of an issue. It is possible to note that this tool is consistent within the culture of knowledge sharing and the concept of the community of learning.

Conclusion

On balance, it is necessary to note that the proposed intervention can be effective in reducing medical error rates and developing the appropriate culture in the organization. The intervention can address issues related to system deficiencies that can hardly be eliminated completely. The intervention is deeply rooted in the culture of the community of learning, where people share experiences and collaborate to come up with innovative strategies.

One of the potential outcomes of the intervention is the establishment of new guidelines and policies that will help in preventing the most common adverse events. The reduction of the medical error rate, as well as the creation of the organizational culture facilitating learning, will have a positive influence on patient safety and patient outcomes. The quality of services provided at the facility can be improved significantly. After the evaluation of the intervention and the introduction of improvements, if needed, it can be used on a larger scale, which can lead to the development of the American healthcare system.

References

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Dekker, S. (2016). Patient safety: A human factors approach. Boca Raton, FL: CRC Press.

Dyab, E. A., Elkalmi, R. M., Bux, S. H., & Jamshed, S. Q. (2018). Exploration of nurses’ knowledge, attitudes, and perceived barriers towards medication error reporting in a tertiary health care facility: A qualitative approach. Pharmacy, 6(4), 120. Web.

Grove, S. K., Gray, J. R., & Burns, N. (2014). Understanding nursing research – e-book: Building an evidence-based practice (6th ed.). St. Louis, MO: Elsevier Health Sciences.

Heale, R., & Twycross, A. (2015). Validity and reliability in quantitative studies. Evidence Based Nursing, 18(3), 66-67. Web.

Hwang, J. I., & Park, H. A. (2017). Nurses’ systems thinking competency, medical error reporting, and the occurrence of adverse events: A cross-sectional study. Contemporary Nurse, 53(6), 622-632. Web.

Kim, L., Lyder, C. H., McNeese-Smith, D., Leach, L. S., & Needleman, J. (2015). Defining attributes of patient safety through a concept analysis. Journal of Advanced Nursing, 71(11), 2490-2503. Web.

Makary, M. A., & Daniel, M. (2016). Medical error—the third leading cause of death in the US. BMJ, 353. Web.

Sarr, F. (2017). Education for community health building a community of learning for the 21st century. Oxford, England: CENMEDRA.

To err is human: Building a safer health system. (2000). Washington, DC: National Academies Press.