Optimal governance of patient safety: A qualitative study on barriers to and facilitators for effective internal audit

Abstract

Objective: While internal audits are widely used, insight into the essential components of the internal audit to govern patient safety is limited. The aim of this study is to explore factors that hinder and stimulate internal audits as an effective patient safety governance tool for hospital boards. Methods: A qualitative interview study in six Dutch hospitals. Interviews (n = 43) were held with auditees, quality officers, boards of directors and boards of supervisors. Data were collected and analysed using Grounded Theory. Results: Barriers and facilitators were classified into 14 categories from which four themes emerged: (1) board positioning of audits, (2) organisation and content of audits, (3) competences and composition of audit team, and (4) cultural factors and attitudes towards auditing. Conclusions: We found two themes consisting of factors related to the audit itself (organisation and content of audits, and competences and composition of audit team) and two themes consisting of contextual factors (board positioning of audits, and cultural factors and attitudes towards auditing). These may contribute to support for auditing and to the generation of reliable audit results, which subsequently could result in effective audits for governance of patient safety. Hospital boards and executives can optimise the patient safety auditing system in their hospitals by increasing active leadership engagement, by promoting audits as an opportunity for staff to learn from safety problems (rather than a mandatory examination instrument) and by providing vital resources for a smooth audit process, such as a medical specialist in the audit team.

Patients and relatives as auditors of safe practices in oncology and hematology day hospitals

“…Somehow there many reasons that could in uence P&Fs preference and willingness to engage in their healthcare. Some studies revealed that there is a general expectation that healthcare professionals, "know what they are supposed to be doing" and a common assumption that they always did what they were supposed to do, specially the most basic duties as washing their hands properly or administering the correct medications 15,[27][28][29] . Also, some studies suggest that checking to ensure that healthcare professionals were doing their job correctly could be embarrassing and damage relationship with them 20,28 .…”

“…Furthermore, it is well established that patients and their families (including friends and informal caregivers) have unique knowledge and are able to detect if their care is safe and patient-centred. 6,[15][16] Patients and their families are present during the whole care episode and often are the only members who are aware of lapses in safety thus being a useful source of information about patient safety. Information gathered by patients and their families (P&Fs) gives healthcare organizations an opportunity to learn and improve the system of care.…”

Important factors for effective patient safety governance auditing: a questionnaire survey

“…At each hospital, different stakeholders were asked to fill in a questionnaire. Stakeholders involved in governance and the auditing process were selected based on a qualitative study [ 13 ] in which a stakeholder analysis [ 20 – 23 ] was performed. The following six stakeholders per hospital received the questionnaire: (1) a member of the board of directors, (2) the chief of medical staff, (3) the nursing officer, (4) the head of the department of orthopaedic surgery, (5) the head of the internal medicine department and (6) the director of the quality and patient safety department (or unit).…”

“…Auditing is a multiple-source method that evaluates whether standards and regulations are being followed [ 10 ]. In contrast to clinical auditing, which focusses on one specific clinical area and is initiated by healthcare professionals [ 11 , 12 ], the audit to which we refer in this study is a hospital-wide audit, which focusses on auditing all departments on a periodic basis and is initiated by hospital boards [ 13 ], as is shown in Fig. 1 .…”

“…Studying a more complete overview of stakeholders, including auditors, clinicians and hospitals boards, provides a more complete overview of essential components for auditing. Recently, a qualitative study was carried out to study which factors hinder or stimulate hospital-wide audits for governance purposes perceived by a wide range of stakeholders [ 13 ]. Findings from this study indicate that four central themes influence effective auditing; two themes consisting of factors related to the audit itself (Organisation and content of audits, and Competences and composition of audit team) and two themes regarding contextual factors (Board positioning of audits, and Cultural factors and attitudes towards auditing).…”