Medical Error and Total Quality Management - Research Proposal Example

MEDICAL ERRORS By (Name) Unit Professor’s name University (Name) Course Date Introduction In the recent past, total quality management has become the cornerstone of many organizations as they devise effective tools for improving their quality of services. Quality within the service sector remains an element of growing concern for sector players including the academicians and practitioners. Provision of healthcare services focuses on ensuring the highest attainable standards in order to minimize costs, reduce pressure on scarce healthcare resources, and improve the outcomes of medical interventions. The focus on quality healthcare is greatly undermined by the alarming incidence of medical errors reported in both the public and the private sectors (Talib et al., 2013). A medical error refers to an act of commission or omission that is unintended and fails to achieve an intended outcome. In some instances, medical errors occur following true accidents while most of them occur when a care provider fails to adhere to a prescribed care standard. Majority of the medical errors are systemic in nature and have a close association with ineffective processes. For instance, sub-optimal staffing levels, or ineffective communication present a challenge for pinpointing responsibility. Medical errors undermine the safety of patient care and lead to unimaginable consequences to the patient, health care provider and the healthcare system (Shanafelt et al., 2010). This paper provides an in depth analysis of medical errors, their occurrence, and appropriate interventions that are useful in reducing their incidence. The review utilizes available evidence to ascertain the prevalence of medical errors and their potential impact on patient safety. The subsequent sections of this paper entail a review of the available literature on medical errors, the methods employed by the researcher to arrive at the findings of this study, analysis of the results, discussion of the findings, and the recommendations of this study. Literature review According to Talib et al., (2012), Total Quality Management draws significant attention from practitioners, researchers, and managers from a particular field. It is important to focus on the people as well as the internal processes in the dynamic environment of quality service delivery. There is need to properly define service quality standards, the measurement instruments, and the quality of customer care strategies. In the health sector, quality services remain a source of concern considering the poor achievement of the desired outcomes and the disparities in healthcare standards across the service delivery spectrum. Medical errors greatly undermine the realization of high quality standards desired by health practitioners while implementing medical interventions (Talib et al., 2012). Medical errors result in disastrous consequences to the patient, responsible healthcare provider, as well as the institution. In order to build a system that provides safe healthcare, it is important to design procedures and protocols that ensure the patient’s protection from accidental injuries. Medical errors result in more deaths when compared to deaths occurring due to automobile accidents. In the United States, an estimated 98,000 Americans die due to medical errors every year (Levinson and Gallagher, 2007). According to Gallagher et al., (2007), almost all doctors have caused a medical error to occur in the cause of their practise and failed to report on the same. Despite the high prevalence of medical errors in the clinical setup, there are very few reports detailing these events translating to lower reporting rates. The underreporting of medical errors substantially contributes to the poor understanding of the factors contributing to their occurrence, their consequences, as well as the appropriate interventions for minimizing the errors. Medical errors affect the responsible care provider, family members, and institutions hence the need for support mechanisms in the event such events occur. Evidence shows that the failure to report medical errors partly results from the perceived negative effect that such a report would have on one’s professional standing and career prospects. Understanding the risk factors for medical errors is very useful in designing appropriate strategies for mitigating medical errors (Gallagher et al., 2007) Most errors amongst physicians are self-perceived and result in significant emotional distress. This leads to the medical professionals experiencing disappointment, guilt, fear, failure, and self-inadequacy thus affecting their professional practice. Junior health professionals exhibit a high vulnerability to medical errors due to a limited experience regarding patient care. Whenever a medical error occurs, it directly influences the future of the health professional including the decisions made regarding their future career. In most instances, health professionals under close supervision fail to disclose a medical error attributed to their actions to their responsible supervisors due to the perceived consequences. On the other hand, trainee health professionals express a more likelihood of admitting their mistakes and work towards constructive changes in their professional practice (Studdert et al., 2006). Medical errors can be reported through continuous reporting on the nature of medical errors occurring within a service delivery unit as well as the appropriate actions undertaken following the occurrence of such errors. According to (Alsulami et al., 2013), it is possible to gain control over medical errors by enactment of appropriate regulatory frameworks that require health practitioners to report the errors . Regulatory agencies outline various measures aimed at improving the safety of patients by minimizing the incidence of medical errors (Lockwood, 2016). Research questions The study seeks to answer the following research questions: 1. What are the causes of medical errors in the UAE healthcare facilities 2. What is the impact of medical errors on patients seeking services in the UAE healthcare facilities 3. What are the appropriate interventions for reducing medical errors in the UAE healthcare facilities Objectives of the study The purpose of this study is to increase understanding of the factors leading to the occurrence of medical errors in the United Arab Emirates as well as the appropriate interventions at the disposal of healthcare facilities. The specific objectives of this study include: 1. To establish the causes of medical errors in the UAE healthcare facilities 2. To assess the consequences of medical errors on patient outcomes in the UAE healthcare facilities 3. To determine the appropriate interventions for reducing medical errors in the UAE healthcare facilities Methods The present study employed a retrospective review data obtained from medical error reports published by the Dubai Health Authority. The researcher obtained 53 incident reports detailing medical errors and reviewed them for relevant data that informed the findings of this study. The reports entailed detailed accounts of medical errors published between the years 2014 and 2015. This review only focused on medical error reports obtained from the public health facilities in Dubai. Secondary research or desk research entails summarizing, synthesizing, and/or collation of data from existing research as opposed to primary research that involves the collection, analysis and interpretation of data from respondents or study subjects. Secondary research does not rely on raw data from respondents but instead the analysis and interpretations of primary authors who study a particular phenomenon. Secondary research is widely practiced in health research, legal research, and market research (Bryman and Bell, 2015; Burns, 2012). Secondary research relies on systematic review as a principal methodology by utilizing techniques in meta-analytical statistics as well as alternative methods such as meta-narrative reviews, and realist reviews. As such, secondary research relies on primary research findings through the utilization of reports and publications. In the context of market research, secondary research involves a second party reusing any piece of data that a primary party collected. During the preliminary phases of a study, researchers rely on secondary research to establish the known concepts about a particular phenomenon thus identify gaps that inform the design of a research study (Baxter and Jack, 2008; Bradshaw and Stratford, 2010). Consequently, the researcher applied secondary research techniques considering the circumstances of the current study. Analysis & Presentation of Results Quantitative data was analyzed using the Statistical Package for Social Sciences (SPSS 22.0) whereas qualitative data was coded and analyzed under various themes. The findings were presented using pie charts, tables and graphs to elicit various statistics relevant to the present review (Bryman and Bell, 2015, p. 126). Results Factors contributing to the occurrence of medical errors The table below is a summary of the findings obtained from the present review showing the distribution of the medical errors every month based on the contributing factors: Table 1: Summary of medical errors reported over twelve months period Factor J F M A M J J A S O N D Frequency Percentage Ineffective communication 3 4 0 1 6 0 3 5 0 0 4 1 27 50.9% Gaps in knowledge or skills 2 0 0 0 0 0 2 0 0 2 0 0 5 9.4% Unclear policies & protocols 0 0 1 2 0 0 0 0 0 0 0 0 3 6% Sub-optimal staffing levels 0 2 0 0 0 2 0 0 0 0 0 3 7 14% Equipment failure 0 0 0 0 0 0 0 0 2 1 0 0 3 6% Poor patient engagement 3 1 1 2 0 0 0 0 0 0 1 0 8 16% Communication problems account for the majority of the medical errors reported at different levels of providing patient care. These occur when the communication approaches utilized by the healthcare providers fail to circumvent all the potential barriers that may result to ineffective communication. In addition, lack of adequate information essential to contribute to quality patient care for instance laboratory results as well as coordinating medication orders is responsible for a significant proportion of medical errors (Studdert et al., 2006, p. 2026). The diagram below is a fishbone chart showing the cause-effect relationship established under this investigation: Figure 1: Fishbone diagram showing the cause effect relationships associated with medical errors (Gygi and Williams, 2012, p. 102) Medical errors also arise from human related challenges such as insufficient knowledge, failure to document patient care adequately, or labelling clearly, and lack of adherence to the prescribed standards and protocols governing patient care. Moreover, patient associated problems namely the failure to identify patients properly, insufficient education of the patient, and the lack of an informed consent prior to medical interventions (Garrouste-Orgeas et al., 2010, p. 123). The table below demonstrates the proportion of the different medical errors reported in the UAE within the period under review: Table 2: Proportion of medical errors reported per 100 cases in the UAE Month Total cases assessed (n) Medical errors reported (np) Defective fraction (p) 1 100 8 0.08 2 100 7 0.07 3 100 2 0.02 4 100 5 0.05 5 100 6 0.06 6 100 2 0.02 7 100 5 0.05 8 100 5 0.05 9 100 2 0.02 10 100 3 0.03 11 100 5 0.05 12 100 4 0.04 Sum 1200 59 =59/1200 =0.049 =0.078 UCL= 0.049 + 0.078= 0.127 LCL = 0.049 – 0.078= -0.029 The diagram below is a p control chart illustrating the findings showed in the table above: Figure 2: P Control Chart (Avg=0.45, UCL=0.127, LCL=0.029 for Subgroups 1-12) There are challenges associated with organizational knowledge transfer to contribute to the occurrence of medical errors. Lack of effective training programs or education of healthcare workers involved in patient care on patient safety as well as the institution’s protocols and procedures lead to medical errors. Sub-optimal staffing below the recommended levels negatively impacts on the quality of care provided by healthcare workers as evidenced by the high levels of burnout recorded under such circumstances (Levinson and Gallagher, 2007, p. 266). Consequently, the overstretched healthcare providers fail to meet the prescribed quality and safety standards prescribed for patient care when they overwork themselves to satisfy the demands from the health care system. It is also important that any given organization enacts appropriate mechanisms for supervising and monitoring the work of various medical personnel in order to minimize the occurrence of medical errors (Shanafelt et al., 2010, p. 998). There is increasing evidence regarding the improper use of medical equipment as well as technical failures leading to medical errors. In addition, medical equipments fail culminating in adverse consequences on the care of patients and occasionally causing preventable loss of life and disability. In some instances, the lack of clear instructions as well as gaps in technical skills regarding the use of the medical equipment contributes to the occurrence of medical errors. Finally, medical errors may arise because of unclear, inexistent, or poorly documented policies, procedures, and protocols that govern the care of patients within an institution (Lockwood, 2016, p. 57). Reporting of medical errors by doctors and nurses Nurses reported majority of the medical error incident reports analyzed in the course of this study. The results of this study indicated that nurses completed 66% of the medical reports analyzed for purposes of this study whereas doctors completed 26% of the reports. The pie chart below illustrates the proportion of medical reports completed by nurses: Most of the medical errors reported by nurses fall in the category of minor medical errors whereas majority of the physician accounts involved a major medical error. A closer look at the medical error reports by nurses and doctors revealed that the latter only made account of medical errors that resulted to major injuries to the patient whereas majority of the nurses reported medical errors that resulted into minor harm. 90% of the nurses reported minor incidents whereas 86% of the physicians reported major events. The pareto chart below demonstrates the factors contributing to poor reporting rates of medical errors amongst doctors. Figure 3: Factors contributing to the poor reporting rates of medical errors amongst doctors Discussion Factors contributing to the occurrence of medical errors The present study established that ineffective communication, knowledge and skills’ gaps, unclear or absent policies and protocols for managing patient care, sub-optimal staffing ratios, equipment failures, as well as poor engagement of patients as the leading contributors to medical errors. These findings are consistent with available evidence from previous studies on medical errors. According to Lockwood, (2016, p.5), ineffective communication is the most common factor contributing to the occurrence of medical errors. The author argued that the absence of a governing framework for communication creates the opportunity for transmitting wrong information from one healthcare provider to the next. In addition, failure to provide adequate amount of information to the next healthcare provider leads to many assumptions during the provision of care especially if the initial health provider is unreachable thus potential creating the opportunity for medical errors to occur (Lockwood, 2016). According to Garrouste-Orgeas et al., (2010), human problems namely one’s failure to adhere to the prescribed standards governing patient care, poor documentation habits, and inadequate knowledge of appropriate medical interventions potentially endanger the safety of patients. The author argued that the human element is a constant factor in the context of medical errors. There would be no medical errors without care interventions prescribed, implemented, and monitored by the clinical care personnel. Consequently, any factor that potentially limits the functionality of an individual leads to a potential medical error. The authors further identified fatigue, anxiety, and undertaking medical interventions under the influence of alcoholic products as human-related factors that undermine patient safety (Garrouste-Orgeas et al., 2010). In another study, it was established that a lower number of nurses below the recommended levels contributed to a significant proportion of medical errors. The authors argued that an insufficient number of nurses at the point of care provision lead to a high work load born by the limited number of nurses eventually resulting to burnout. Without adequate measures, the productivity as well as the judgement of the nurses reduces thereby posing a threat to the safety of the patients. According to Ulanimo et al., (2007), sub-optimal staffing ratios contribute to medical errors by undermining effective communication amongst healthcare providers occasioned by the huge workload. Lack of an adequate number of medical professionals undermines supervisory functions in patient care since majority of the available staff are deployed to provide direct patient care (Ulanimo et al., 2007). Reporting of medical errors This study established that nurses had the highest levels for reporting medical errors occurring in the course of their care delivery. According to Wolf and Hughes, (2008, p.345), nurses have a higher level of awareness on when to report medical errors as opposed to physicians. The authors noted that nurses expressed an in-depth understanding of reporting medical errors and consequently reported most of them because they perceived their reporting to benefit patient care. In addition, the nurses feel more comfortable to report medical errors, provide patient-centred care, and perceive medical errors to have dire consequences hence opting to report them as they occur (Wolf and Hughes, 2008). Wolf also established that nurses understood the use of medical error reporting tools in comparison to their physician counterparts hence the higher reporting rates. In addition, the authors established that most nurse had more experience in reporting medical errors and understood the hospital procedures involved thus translating to higher rates of reporting. In another study, it was established that physicians abdicated the duty of reporting medical errors to nurses due to their misunderstanding of the relevant protocols (Wolf and Hughes, 2008). This study established that nurses reported even the least kind of incidences that resulted to minor harm to the patient whereas the doctors concentrated on reporting medical errors that caused significant harm to the patient. These findings are consistent previous studies, which suggest that clinicians can only report what they understand based on their definitions of medical errors. According to a study on medical errors published in England indicated that care providers fail to document medical errors due to the perceived consequences that such reports would have on their practice as well as their practice. Consequently, physicians attach more value to the nature of medical error instead of the importance of availing the required reports to the relevant authorities (Sanghera et al., 2007). Prevention of medical errors The present study established the various factors that contribute to the occurrence of medical errors. In order to minimize these errors, it is important to design interventions that mitigate these factors by prioritizing patient safety. Ineffective communication should be addressed by developing applicable standards to govern communication practices. According to James et al., (2009), healthcare providers require adequate sensitization on the communication requirements involved in patient care as well as adherence to the prescribed communication tools. This ensures uniformity in communication practices and minimizes the chances of relaying wrong information to the subsequent healthcare providers. The hospital management should also conduct a needs analysis as well as identify gaps in reporting practices by various healthcare providers and initiate capacity-building interventions for the care providers (James et al., 2009). Continuous monitoring and evaluation of patient care is very useful in reducing the incidence of medical errors. This identifies quality gaps on various aspects that could potentially undermine patient care and cause medical errors. Monitoring and evaluation requires a multidisciplinary approach in the identification of various challenges that undermine patient care. Clinical audits provide a good source of information thereby providing an opportunity for the hospital management to develop mechanisms for ensuring patient safety. Moreover, clinical audits are useful in the identification of supervision needs of various departments to optimize patient (Deans, 2005). This study identified lack of skills and knowledge as a potential contributor of medical errors. It is important that the hospital management creates opportunities for the healthcare providers to access latest information on the appropriate medical interventions. In a study conducted by Lockwood, (2016), continuous professional development activities as well as on job-trainings are useful in harnessing the knowledge and skills of healthcare professionals. In the event the hospital lacks technical experts in various fields, it is important to train the care providers or recruit trained experts to bridge the gaps that could potentially jeopardize patient care (Lockwood, 2016). Recommendations & Conclusion Failure to report medical errors significantly jeopardizes ongoing patient care as well as patient safety. Based on the findings of this study, it is recommended that the hospital management should create awareness on the importance of reporting medical errors by all healthcare professionals. This will also include orienting the healthcare providers to the different tools and procedures involved in reporting medical errors. In addition, clinical teams should implement ongoing clinical audits that would identify quality gaps that have the potential to cause medical errors and work towards addressing them. Implementation of mentorship programs for healthcare professionals especially nurses, pharmacists, and physicians will help minimize the incidence of medical errors. In cases where there is lack of the required experts, the hospital management should set up telemedicine facilities to allow for continuous consultation between experts on different subjects thus minimizing the chances of medical errors. On the other hand, the government should continue towards optimizing the ratios of healthcare providers to the patient population in order to reduce work load and maintain better performance. In conclusion, the factors contributing to medical errors include ineffective communication, knowledge and skills’ gaps, unclear or absent policies and protocols for managing patient care, sub-optimal staffing ratios, equipment failures, as well as poor engagement of patients. Nurses have the highest rate (90%) for reporting medical errors occurring in the course of their care delivery. 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Wolf, Z.R., Hughes, R.G., 2008. Error reporting and disclosure.  Read More