Adverse Events in Healthcare and the Ability to Improve the Quality and Safety of Patient Care in the Hospital

1 online resource (185 pages) : PDF

2015

University of North Carolina at Charlotte

This dissertation examines the influence of external and internal constraints on adverse event management in hospitals. Using a multilevel organizing framework, in three separate studies I explore the mechanisms of constraint that impact adverse event management and contribute to organizational processes designed to promote organizational learning and performance improvement initiatives to advance patient safety. The first study, Chapter 2, examines state mandated adverse event reporting and the impact on patient safety. Mandated reporting of adverse events is an environmental level influence to coerce hospitals to improve patient safety through the mechanisms of identifying and addressing patient harm resulting from medical management. Analysis revealed no association between state mandated reporting of adverse events and patient safety. These findings suggest current environmental regulations in the form of mandated reporting have limited impact on patient safety. The reporting of adverse events may not be enough to prompt hospitals to focus on opportunities for improvement. The next two studies, Chapters 3 and 4 employ an exploratory qualitative approach to examine organizational management of sentinel events, a subset of adverse events, in hospitals. In Chapter 3 I explore the sentinel event management structure and influences that impact the management structure within the constraints of internal influences. Hospitals exhibit significant coercive, normative, and mimetic influences constraining the management of sentinel events that yields limitations in organizational learning and performance improvement initiatives to impact patient safety. These findings reveal multiple and varied constraints inform organizational design of sentinel event management programs. Sentinel event cases generate significant attention at high levels of hospital administration and provide the basis for organizational learning. The third study, Chapter 4, explores sentinel event data collection and the application of a classification system using the principles of system safety and human factors to aggregate and analyze sentinel event data at the hospital level. Findings indicate the methodology developed for data collection and application of classification codes provides a mechanism for hospitals to manage sentinel event data in aggregate as a way to identify system-focused improvement initiatives. The combination of mechanisms of constraint limits organizational learning thus restricting opportunities for performance improvement. The multiple constraints of hospital management of adverse events is impacting efforts to improve patient safety and these mechanisms must be recognized as challenges in the complex hospital environment.

doctoral dissertations

Government policy

Ph.D.

Adverse Events
Hospital Adverse Event Management
Organizational Learning
Patient Safety
Patient Safety Taxonomy
Quality Improvement

Public Policy

Scheid, Teresa

Brandon, William
Troyer, Jennifer
Laditka, James

Thesis (Ph.D.)--University of North Carolina at Charlotte, 2015.

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WalshKoricke_uncc_0694D_10775

http://hdl.handle.net/20.500.13093/etd:1215