Contemporary Patient Safety and the Challenges for New Zealand
Author: Beaver, Peter J, peterbeaver@gmail.com
Department: Sociology
University: University of Auckland, New Zealand
Supervisor: Associate Professor Steve Matthewman
Year of completion: In progress
Language of dissertation: English
Keywords:
Patient Safety
, Hospitals
Areas of Research:
Health
, Institutional Ethnography
, Organization
Abstract
In this thesis I explore the challenges of reducing harm and implementing safety improvement from the perspectives of staff in NZ hospitals. Medical harm is a previously ignored and now internationally recognised threat to public health. In the last decade and a half progress towards safer care has been slow and remarkably difficult in all advanced systems of healthcare. In this thesis I review the discovery and measurement of medical harm, strategies for improving quality and safety, and policies effecting hospitals in America, England, and New Zealand (NZ). Safety achieved prominence in policy in NZ around 2000, but it was compromised by resource shortages, a lack of central support and coordination, and disengagement between managers and healthcare professionals. Since 2008 there have been efforts to improve managerial-professional relations, and provide greater support for quality and safety. My interpretation of how hospital staff currently perceive safety is assisted by reviews of the literatures about risk, and about safety improvement. I argue that the strategic focus for risk control must be given to issues of pressure, communication, and culture. While the implementation of safer practices is a key challenge, there is now an accumulation of knowledge about the social and organisational dynamics of change, which shows that successful improvement is difficult, but possible. However my qualitative explorations with staff in this thesis highlighted many challenges that had not been overcome. The most prominent was short staffing, which drove pressure, and contributed to poor communication and breakdowns in teamwork. Risks were not always well controlled and improvement practises showed the impact of pressure. Staff supported some practices and criticised others as ineffectual or contributing to pressure. Nurses often felt disempowered. Doctors who were interested or involved in improvement could be frustrated by the lack of capacity to start and complete projects. While hospitals supported some changes, their overall capacity was limited. This thesis contributes to the currently brief literature about social and organisational patient safety processes in NZ. I argue that current tensions between the needs of productivity, and the needs of safety, are unresolved.
