Article Text

Download PDFPDF
Critical relationships in the quality and safety of health care
  1. T Smith
  1. Senior Policy Analyst, BMA Health Policy & Economic Research Unit, London, UK;

    Statistics from

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    The papers in this issue of JournalScan explore relationships that are each thought central to the quest of improving the quality and safety of health care. They relate to the following different dimensions:

    • relationships between organisations and professionals;

    • relationships between patients and professionals;

    • relationships between professionals and within teams.

    Two of the papers consider the methodology of relating health policies to the communities they serve.

    Relationships between organisations and health professionals

    Improving reporting systems in hospitals ▸

    A paper by Crawford et al in the Journal of Medical Systems analyses medication errors that “result from process breakdowns in organizational systems” and that “should be preventable with effective organizational processes and systems controls”. The study sought to identify systems factors related to higher levels of error reporting. It investigated a range of hospital systems factors—the “multifactorial and interdisciplinary problems and sources” of medication errors.

    Hospital policies, procedures and practices were surveyed in 201 hospitals. Based on a review of the literature, a number of independent variables were tested. These included:

    • existence of formal committees for the review and evaluation of error reports;

    • staffing ratios of pharmacists and registered nurses per occupied bed;

    • baseline screening or testing of nurses on proper medication use and preparation;

    • use of computerised medication administrative records;

    • 24 hour pharmacy service;

    • use of patient focused care models.

    There was an 84% response rate (169 questionnaires) based on 156 hospitals. A total of 951 serious medication errors were reported for the previous year, nine of which resulted in patient death and 12 caused permanent impairment of body function. The hospitals were divided into two groups—low and high reporters. The first group reported no more than two incidents (39%) and the second reported 6–32 incidents (38.5%). A middle group was excluded from the analysis. The study found that the reasons behind “increased reporting of medication errors warrants serious evaluation, but does not …

    View Full Text


    • Compiled by Tom Smith