Health care providers are constantly striving to improve quality and efficiency by using performance management systems and quality improvement initiatives. Creating and maintaining a culture of accountability are important for achieving this end because accountability is the reason for measuring and improving performance. The keys to creating a culture of accountability will be explicated by examining the extant literature, and from this, 6 methods will be outlined for creating such a culture.
Background/Objective Canada, like other industrialized countries, aims to provide safe healthcare to its citizens that meets the fiscal responsibilities of delivery in an efficient manner. This is evident from many initiatives across the world aimed at improving patient safety, such as the Institute for Healthcare Improvement's 100,000 Lives Campaign in the United States and the Safer Healthcare Now! initiative in Canada. A key component of improving patient safety is the prevention and management of medical error. Successful management of such errors and changes aimed at reducing the likelihood of their occurrence can have a significant impact on improving patient safety and quality of care, thereby resulting in fiscal benefits to the system. There is substantial evidence suggesting that medical errors are a leading cause of death and injury (Kohn et al. 1999). According to the Canadian Adverse Events Study, 7.5% of patients admitted to acute care hospitals in Canada during 2000 experienced an adverse event, with 36.
Improving customer-service in health care organizations has been linked to better patient care, satisfied staff, a reduction in preventable medical errors, fewer malpractice lawsuits and improved revenue. However, it has been observed that there is sometimes a gap between the level of customer-service provided by health care organizations and their clients' expectations. This paper integrates, synthesizes and extends theory and practice from existing literature to provide health care organizations with strategies for closing this gap. Methods are also outlined for creating, implementing and evaluating an organizational plan for improving customer-service.
Purpose The purpose of this study was to determine the rate of self-reported errors in Canada compared with other countries, and to identify risk factors for medical error. Methods In 2007, the Commonwealth Fund surveyed a sample of adults in 7 industrialized nations: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom and the United States. The surveys were conducted by telephone by Harris Surveys and country affiliates, with an average interview time of 17 minutes. Data from this source was used to perform a bivariate analysis comparing those individuals who reported having experienced a medical error to those who had not, followed by a logistic regression model in order to delineate the relationship between medical error and several explanatory variables. The goodness of fit of the final model was assessed, as was the possible presence of multicollinearity. All data analysis was performed using SPSS Version 16.0. Results Overall, 11,910 respondents from 7 countries were included in the analysis. The rate of self-reported medical error ranged from 12%– 20% in the 7 nations. Approximately 1 in 6 (17%) Canadians reported having experienced at least 1 error in the previous 2 years, which translates to 4.2 million adult Canadians. Several variables were found to have a statistically significant relationship to self-reported medical errors in the final regression model, including high prescription drug use (4 or more medications), presence of a chronic condition, lack of physician time with the patient, age under 65, lack of patient's involvement in care, perceived inadequate nursing staffing and absence of a regular doctor. Conclusions This study has demonstrated that medical error is a commonly occurring problem from the perspective of patients in 7 industrialized countries. The risk factors for self-reported medical error that have been identified in this study should aid clinicians, including pharmacists, in the design and implementation of targeted strategies to address this issue. By proactively identifying patient, provider and system-related risk factors for medical error, the opportunity for improving the safety of Canada's health care system could be greatly enhanced. While not all of the errors identified in this study are related to medications, there are implications for pharmacy practice. More specifically, our results suggest that pharmacists should be extra vigilant with patients with high prescription drug use and chronic conditions and ensure that patients are given the opportunity to be involved in their care.
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