136 e-Letters

  • The Problem with Root cause analysis
    Siti Hosier

    I read with interest the article by Peerally et al (1) on 'The problem with root cause analysis'. I reflected on the recent cases that happened at Royal North Shore Hospital and Sydney Hospital (2,3,4) which led me to consider which investigative tool is best applied to different incidences and identified risks. The use of appropriate tools and involvement of key stakeholders are crucial elements to a successful investig...

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  • A role for patients and the public in improving healthcare
    Sharon Walsh

    I read with interest the article on what role the patient and public should play in healthcare improvement (1) as this is a question that my organisation has long grappled with and is now required to achieve accreditation against the mandatory National Safety and Quality Health Service Standards (2).

    For many years we had a strong Community Advisory Committee and consumers on all key quality and safety committe...

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  • The overuse of thromboprophylaxis in medical patients
    Manuel Monti

    In the important editorial of the Grant, is underlined the overuse of thromboprophylaxis in patients hospitalized in the medical field. We agree in emphasizing the difficulty of proper patient assessment that must be carefully evaluated, considering comorbidity and various risk factors,and using the main scores currently in use to assess the start of tromboprofilattica therapy. For this reason we carried out a study where...

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  • Black box medicine: a structured approach to organisational reflection on major maternal morbidity as a tool for effective organisational learning
    Alexander Davey
    Editor - Professor Knight(1) highlights a serious problem with systems of organisational learning in maternity care that is endemic across a variety of acute care settings in the NHS. I write to share my experience with a trainee based structured case note review method so other organisations and patients may benefit from what I refer to as a black box medicine (BBM) approach to major maternal morbidity. Trainee based mixed expl...
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  • Worthless Statistics in search of Meaningful Conclusion
    Louise B Andrew

    It appears that these authors believe that variability in the disciplinary rates between states is something that indicates a lack of quality and/or a lack of uniformity of safety measures.

    Nothing could be further from the truth.

    There are many more reasons affecting a state's disciplinary rates than those controlled for in the study. For just one glaringly obvious example, in certain states and i...

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  • Why do we love to hate ourselves?
    Robert L Wears

    Dhaliwal's comment [1] on Zwaan et al [2] nicely refutes what has been called "the hypothesis of special cause" [3] - the notion that when things turn out wrong, the cognitive processes leading to that outcome must have been fundamentally different (ie, error-prone) from when they turn out right. Dhaliwal's argument recapitulates thinking that is over 100 years old; one of the early contributors to psychology, Ernst Mach, wr...

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  • Statistical Process Control and Interrupted Time Series
    Alan J Poots

    I read Fretheim and Tomic's article [1] with interest as I trained in frequentist stastistics and now work primarily with Stastistical Process Control (SPC) in quality improvement (QI) initiatives.

    I concur that there are missed opportunities for using Interrupted Time Series (ITS) in QI; however, I note cautions in doing so:

    Regression models applied in ITS often have the assumption of homoscedastici...

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  • Hand Washing is about Respect for Patients
    Daniel L Cohen

    The paper by Redelmeier and Shafir resonated strongly with me because I have always believed that there are important factors that motivate some physicians to wash their hands while others behave differently. I agree completely that this is a more complex issue than has been previously noted. I always wash my hands in front of patients and have done so for over 40 years. This has very little to do with the risks of healthc...

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  • What did Albert Einstein ever do?
    Robert L Wears

    Reed and Card's essay on the problem of valuing action over thought could not have come at a better time. For years, quality and safety mavens have been paraphrasing Goethe -- "Knowing is not enough ... we must do". But the resulting culture of 'do, do, do' has brought us quite a lot of doo-doo.

    To counter this, consider the question, "What did Einstein ever do?" He invented nothing, patented nothing, created n...

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  • Patient-centered bedside rounds-Exploring patient preferences before patient-centered care
    Naseema B Merchant

    Dear Editor,

    It was with great interest that we read the study of O'Leary et al published in the December issue of the journal and were quite surprised by their findings that patient centered- rounds had no impact on patients' perceptions of shared decision making, activation, and satisfaction with care.1

    Previous studies have shown that patients prefer their rounding team conduct rounds at the bedside...

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