Managers Role in Patient Safety - Essay Example

?Managers Role in Patient Safety Compare and Contrast High Reliability Theory and Normal Accident Theory Introduction Since the last century, the healthcare system in the United States has undergone a number of changes in regards to the creation of policies and models that are meant to improve safety in the healthcare system. Safety is an important factor in any healthcare setting or even in an organization, and therefore, there is the need to have proper theories in place to guide the organization. A number of theories have been developed in the last century, but the most notable ones include the high reliability theory and the normal accident theory. Although both theories target different aspects, they have been shown to work well when they are used together. The paper will attempt to compare and contrast high reliability theory and normal accident theory. High Reliability Theory High reliability theory suggests that intelligent organizational management and design can prevent serious errors when the following four factors incorporated in the system. These factors include safety as the main concern, high redundancy in both personnel and technical systems, well-established trial-and-error structural learning procedures, and decentralized operations. The main belief of this theory is that errors or accidents can be averted through good organizational management and design (Compton 2008, p77; Malloch 2009, p123). Redundancy improves safety as overlap and duplication can make a system reliable instead of unreliable. Continuous training, simulations, and evaluation further maintain and support high-reliability operations. In addition, trial-and-error learning accidents are thought to be necessary and effective (Malloch 2009, p123). The basic theory of organizational reliability is supposed to integrate the possibility of multiple forms of errors and must speak of the present debate between normal accident scholars and high reliability theorists. In making a clear difference between normal accident and high reliability theory, it should be distinguished that the line between these two theories is not clearly drawn. As aforementioned, there are four maxims that must be followed to ensure consistent management of risky technologies. The first commitment by the organizational leaders to make sure that safety is given a priority. Such commitment is very crucial in part since reliable management is a perpetual and an expensive goal (Heimann 2010, p8; Sagan 1993; Welzel 2012). Unless the organizational leaders make safety the priority, it is most likely that they will be motivated to use the funds for other purposes, and therefore, undermine the resource base that is important to the maintenance of reliable performance. Additionally, such an obligation by the organizational leaders is crucial in order to convey this effectively and clearly to the rest of the organization. It is essential to state that hierarchical control is not effective in the absence of a trustworthy commitment to the goals of the organization by the upper-level management (Heimann 2010, p9). The second crucial element of high reliability theory is the necessity for redundancy between and within organizations. When individuals operate in a redundant organization structure, their failings can be limited by the system. In this instance, duplication is an ancillary for perfect sections. Therefore, high reliability theorists state that using redundant organizational designs is a proper means for minimizing the likelihood of failure within the agency (Heimann 2010, p9). The third element of high reliability theory is the development of a culture of reliability in the organization. Appropriate socialization of subordinates can improve safety by encouraging proper and uniform responses by operators in the field. The socialization, in turn, permits the organization to decentralize authority to subordinates with the confidence that they will take proper action concerning safety issues. Because of such decentralization, the organization gets greater flexibility in reacting to any irregularities that happen with new technologies (Heimann 2010, p9). The flexibility becomes essential in containing the damage instigated by technical failures and averting these accidents from becoming serious mishaps. The fourth and final component of high reliability theory is the essence of organizational learning. The small-scale botches caused by technological anomalies can offer the organization valuable information concerning possible dangers. An organization can engage in a learning practice of sophisticated trial and error through the simulation of probable failures and comprehensive testing. For instance, the FDA (Food and Drug Administration) is a good example of this knowledge (Heimann 2010, p9). FDA requires animal testing of all the new pharmaceuticals, and it restricts the number of human subjects in Phase I clinical trials. In such a process, the agency hopes to remove a majority of the dangerous drugs in the early stages of the process, and therefore, reducing the risk new drugs put to the population. A number of scholars have indicated that highly reliable organizations use some mix of the aforementioned principles to make sure that the probability of catastrophic failure is insignificant (Heimann 2010, p9). To progress safety performance, most of the health care organizations have sought to imitate high reliability organizations (Carroll and Rudolph 2006, pi4; Institute of Medicine 2001). In experimental research, the main features of high reliability organizations include serious consequences of error, sophisticated high-risk environments, collective mindfulness, continuous improvement, proactive and positive safety culture, and highly trained and rewarded staff. Other features include learning culture, regular checks, flexibility to deal with change, redundancy of processes, and innovative methods to cope with errors. It is important to note that there is minimal empirical evidence that explores the link between safety culture and high reliability, or whether creating specific features of high reliability organization can lead to enhanced safety culture. There is an assumption by literature that the theory has positive safety culture (The Health Foundation 2011, p6). It is imperative to state that hospital practice and organization diverge considerably from the components of high reliability organizations (HROs) (Gaba 2000, p84). A HRO is regarded as which has measurable close perfect performance for safety and quality (Harrison and Tamuz 2006, p1658; Riley 2009, p238). Hospital managers generally pursue conflicting and multiple goals. The objectives and practices of clinicians may diverge from management’s advocated goals for quality and safety. Most of the social and technical features of hospitals indicate redundancy, but not all of them contribute to reliability and safety. Much of the space between the HRO model and hospital realities emphasizes the reason why hospitals are professional bureaucracies (Harrison and Tamuz 2006, p1658). In this instance, routines and norms and learned through authority flows and professional socialization through professional hierarchies. Additionally, clinicians readily change decision-making responsibility in reaction to the changing conditions (for example, emergency codes) which is not the case in hospitals. Hospitals tend to be lightly coupled. Loose or light coupling of routine activities gives the providers the capability to recognize problems and intervene before they lead to harm. Similarly, alterations in one unit do not affect the other units. Except for emergencies, time delays can be tolerated by the hospitals (for instance, a patient sent for imaging tests) and sequencing of processes is generally flexible (for example, scheduling medication administration and imaging tests) (Harrison and Tamuz 2006, p1658). Normal Accident Theory Normal accident theory relies on the assumption that accidents are unavoidable in complex systems (Akerboom, Beuzekom, Boer, and Hudson 2010, p53; Dain 2002). The theory in most ways has an inconsistency in the philosophical decision-making. Normal accident theory raises alertness of the unavoidable risks and vulnerabilities of major systems failures in industries using tightly coupled interactively complex technologies. Decentralization is therefore important to manage the complications in the system. Centralization on the other hand is expected to ensure timely controls and regularization (Malloch 2009, p123). System redundancy is thought to be the major source of accidents and further accelerates shared complexities, which in turn encourage improper risk taking. The theory is almost similar to the military model that entails strong control and discipline, which differs from the model of collaborative decision-making and shared leadership. An organization can never train for an improbable, dangerous or a politically unacceptable situation within this hypothetical framework. The most problematic belief on this theory is that it includes the refusal of personal responsibility, negative value of going through erroneous incidents and faulty reporting (Malloch 2009, p123). Normal accident theory focuses on two features of the system. These two features include the complexity of relations between system features and the existence of tight coupling among the system features (Miller 2010, p97; Roe and Schulman 2008, p64). A system is said to be tightly coupled when a change in one of the system changes other parts of the system. Some physiological systems are buffered from changes in others while other core elements like oxygen delivery and blood flow interact strongly and are tightly coupled (Miller 2010, p97). According to the theory, it is believed that individuals delude themselves by believing that disaster and hazardous technologies are hard to control. Instead, it has been noted that the efforts that are made during the design and management have proved to increase the complexity and opacity of the systems therefore increasing the risk of accidents. The theory is often considered pessimistic because of its focus on industries (Bennett and George 2005, p118). It also encourages political leaders to abandon or totally rearrange systems founded on high-risk technologies (Miller 2010, p98). A notable contribution of the normal accident theory according to (Rosness, Grotan, Guttormsen, Herrera, Steiro, Storseth, Tinmannsvik and Waero 2010, p 53) was that it raised the discussions regarding the limits of safety in complex systems. Additionally, the theory inspired a research on HRO. Although the theory has some positive contributions, it received some opposition against it. These oppositions included: a. The idea of tight coupling and interactive complexity have been said to be vague such that it is hard to put the theory to realistic tests. b. Major accidents researches suggest that most accidents are caused by other problems other than a disparity between degree of centralization and complexity/coupling. c. It is sophisticated to develop an effective and simple prescription for checking major accident risks from the normal accident theory because it is challenging to monitor or measure such features as decentralization or collaborative complexity. d. The allegation that an organization cannot be decentralized and centralized at the same time sounds like repetition. However, the allegation has been challenged by scholars that study the so called High Reliability Organization e. Some criticizers find the idea that some technologies should be rejected too cynical, politically unacceptable, or too passive (Rosness et al. 2010, p53). The normal accident theory is restricted in its applicability. The theory addresses a narrow group of accidents such as industrial disasters of unexpected events causing great loss and damage. Therefore, it has not been prolonged to the more commonly faced accidents of restricted scope. Secondly, the theory addresses safety in the perspective of organizational structures for sophisticated, industrial systems such as oil refineries, nuclear power plants, and chemical plants. Therefore, it does not concentrate on the particulars of the system and its parts. Thirdly, the theory has not been stretched to computerized systems utilizing software (Perrow 1999, p354; Sammarco 2005, p3). Normal accident theory is also restricted by the absence of modification in quantifying and defining its concepts and terms. Vague concepts and the lack of criteria for measuring coupling and complexity have been cited as important limitations. Quantitative measures of interactive coupling and complexity would address these restrictions and could assist in the promotion of the theory in new areas (Hopkins 1999; Sammarco 2005, p4). Therefore, as aforementioned, the theory is restricted in its applicability. Conclusion Based on the analysis done, the theory that can best be used in the health care setting is the high reliability theory. The choice of the theory is based on the benefits it offers to the organization. The theory is assumed to enhance reliability in high hazard environments, its orientation is melioristic, and optimistic (in other words, it focuses on the internal organizational culture and practices). On mitigating risks, the theory assumes that the managers recognize the existence of the risk and therefore, they can develop strategies to cope with the risk. Other benefits of the theory are that the top managers get the big picture and the individuals participate in reliable and valid sense making. These and among other many features make the theory suitable for the health care setting. Future Recommendations The two theories can be used together in the context of a health care setting despite their shortcomings. Research has shown that the two theories can be used in a particular health care setting (Cooke 2009, p256). Therefore, instead of applying only a single theory to a health care setting, it would advisable if a number of theories can be used in a particular setting. For instance, research indicates that each of the aforementioned theories (high reliability theory and normal accident theory) can make significant contribution to enhancing patient safety. The research further states that by applying the normal accident theory and high reliability theory frames, health care administrator and researchers can recognize health care settings in which existing and new patients safety interventions are expected to be effective. Additionally, they can learn on how to enhance patient by both analysing the mishaps and learning the organizational outcomes of adopting safety measures (Harrison and Tamuz 2006, p1654). References Akerboom, S., Beuzekom, M., Boer, F., & Hudson, P. (2010) Patient safety: Latent risk factors. British Journal of Anaesthesia, 105(1), pp52-59. Bennett, A., & George, A. L. (2005) Case studies and theory development in the social sciences, Cambridge: MIT Press. Carroll, J. S. & Rudolph, J. W. (2006) Design of high reliability organizations in health care. Quality Safe Health Care, 15(1), ppi4-i9. Compton, D. S. (2008) High reliability leadership: Developing executive leaders for high reliability organizations, Ann Arbor: ProQuest LLC. Cooke, H. (2009) Theories of risk and safety: What is their relevance to nursing? Journal of Nursing Management, 17(2), pp256-264. Dain, S. (2002) Normal accidents: Human error and medical equipment design 1. Heart Surgery Forum, 5, pp254-257. Gaba, D. M. 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Continuing Medical Education, 30(11). Source: CMJ [online]. Read More