Edited by KieranWalshe and RuthBoaden . Published by Open University Press , 2006 . Paperback , 288 pages. RRP $62 . ISBN 0335218539. .
Reviewed by Stephen Duckett, Queensland Health
There is a burgeoning international literature on patient safety as awareness of the risks of health care and the incidence of adverse outcomes is highlighted in the professional literature and the public domain. The usual approaches of ignoring slips, mistakes and other causes, dealing with them informally through an old boys’ network or laying blame on individuals when underlying causes are systemic, are no longer appropriate. Most of the patient safety literature is related to hospitals, possibly because of the more systematic nature of regulation of hospital services and the greater availability of data on hospital care.
This edited collection is English: the first author of 14 of the 15 chapters is from that country and most of the collaborating authors are also from England. At 244 pages it is a slim volume, relatively easy to read, and provides a good introduction to the multiple perspectives in patient care. It is useful reading for those embarking on work in this area.
It is a comprehensive collection, the first part covering a variety of perspectives about patient safety and highlighting the different contributions that different disciplines can make (clinical, sociological, psychological, legal), together with chapters on quality management and informatics. Some of these contributions are novel, providing new insights into the disciplinary contributions and the perspectives they bring to bear on analysing causes or consequences and strategies for improvement in safety.
The second part is more overtly methodological, focusing on data collection and analysis, with chapters on taxonomies, incident reporting and methods for identifying and analysing adverse events. The final part includes chapters on patient safety education, team performance (complementing an earlier chapter on evaluating patient safety culture) and use of rules and guidelines. Although this last part of the book is called ‘Patient Safety in Practice’, it does not include chapters on contemporary high-priority strategies to improve safety such as handover, hand hygiene, falls etc, nor does it include a section on dealing with poorly performing professionals. Despite advocacy of a systems approach, sometimes there are problems that are related to individual performance, either blameworthy or not, and the book does not incorporate a chapter on dealing with performance issues of individual clinicians.
The book is written within the contemporary paradigm of patient safety, namely an emphasis on a systems approach to understanding the path of causation of most adverse events. A book of this kind inevitably involves choices as to what is included or excluded. Perhaps it might have benefited from a greater emphasis on context: the contribution of a historian or political historian might have been relevant here, tracing the concepts of, and contributions to thinking about, patient safety from Florence Nightingale through Ernest Codman to the Bristol scandal and its responses.
The English origins of the book perhaps explain the lack of emphasis on pay for performance, a high-profile though predominantly North American strategy to improve safety and quality through standardisation of care. A similar lacuna is the relative de-emphasis on analysis of routine datasets to understand incidence of adverse events compared with collecting information on reports of incidents. Scotland's emphasis on the contribution of clinical networks to promoting quality and safety is also missing. Finally, it was striking that there was no author writing from a patient perspective, although obviously some issues that might have been raised from a patient's perspective were covered in the existing chapters.
Despite these gaps, the book is a valuable addition to the patient safety literature. It collates in one place insights from a range of disciplines that are rarely brought together in this field. It appropriately adopts a systems approach and provides support for that. People new to patient safety are encouraged to read this work and, because of the breadth of the book, old hands would also benefit from browsing through it.