Patient safety management in the health services- what do patients want?


This issue of the Journal of Nursing Management focuses on empirical research that provides nurse leaders with new knowledge in order to ensure safer and more efficient health care. By presenting new knowledge from a range of studies of quality and safety, the issue is intended to improve the quality of care and patient safety in hospital and community settings. Systematic development of patient safety is necessary as poor quality of care causes human suffering (Macchi et al. 2011). Commission of European Communities (2008) defined patient safety as the prevention of unnecessary or potential harm associated with health care. Other definitions are related to the dynamic system of health care and focus on the interaction of several elements (World Health Organization (World Health Organization 2008, 2009). These definitions assume that incidents are the result of ineffective interaction between the actors involved (Wiig & Lindøe 2009). Evidence has been accumulated of the important role of context in patient safety practices (Taylor et al. 2011). The latter study revealed that four domains are important for the implementation of such practices: (1) safety culture, teamwork and leadership; (2) structural and organisational characteristics (e.g. size, organisational complexity and financial status); (3) external factors (e.g. financial or performance incentives and patient safety practice regulations); and (4) availability of implementation and management tools (e.g. training resources or internal organisational incentives) (Taylor et al. 2011, p. 611).

Patient safety culture, teamwork and leadership

Teamwork and leadership are core components in the provision of quality care and thus influence the improvement of patient safety practices. In the following, the papers included in this issue are introduced with reference to the above-mentioned aspects of patient safety practices and culture with specific focus on enhancing nursing leadership and management.

The role of clinical leadership in promoting higher quality and safer care has been studied by Enterkin et al. (pp. 206–216), who developed a leadership education programme for nurses. Laschinger et al.'s (pp. 217–230) excellent research examines the influence of situational factors on direct-care nurses’ interest in pursuing nursing management roles. Also included in this issue is a study by Wong et al. (pp. 231–241) about the development of nurses’ interests in formal management roles. The authors conducted 18 focus group interviews with staff nurses and managers in Canada and their suggested implication for organisations and nursing management is facilitating staff nurses to attend leadership development courses. Organisations need to provide leadership support and opportunities for advancement. Other research in the area of learning and leadership includes the interview study by Thurgate and co-authors (pp. 242–250) addressing clinical managers’ experiences of training in the associate practitioner role and how it is defined by competence, boundaries and the skill mix required for specific team function. Employing a grounded theory approach, Palese et al. (pp. 251–262) investigated the need for further nursing leadership theory. The authors explored the relationship between a nursing system and patient outcomes in an Italian context. The paper also describes different theoretical models that explain variations in patient outcomes and adds to the knowledge of how to create an effective nursing environment that ensures assure optimal patient outcomes and safety.

Structural system and organisational characteristics

Different systems and work environment have a major influence on patient outcomes. The papers included in this issue also report on expectations and experiences of group supervision. Andersson et al. (pp. 263–272) highlights the nurse managers’ vital task to support nurses in their educator role in order to strenghthen nursing students’ learning as well as collaboration and communication between nursing colleagues. Thus, organisational support such as group supervision increases professional identity, team communication and awareness of patient safety. The study by Charalambous et al. (pp. 273–282) focuses on job satisfaction in the oncology and haematology nursing setting by testing the job diagnostic survey tool using confirmatory factor analysis for the five job dimensions factors. The study by de Cordova et al. (pp. 283–292) deals with off-shift nursing and patient risk when admitted to hospital at night or on weekends. An important implication for nurse managers is to consider both staffing and experience levels when planning off-shift staffing, since a reduced number of ancillary personnel often results in more tasks for nurses, thus increasing their workload. Finally, an Australian study by Gibb (pp. 293–303) validated an evidence-based method for conducting environmental scanning in elder care. The aim was to deepen understanding of elder care work culture and to ascertain the readiness of staff members to move towards the provision of team-based quality care.

A review of several electronic databases was conducted to identify available patient safety literature. The result revealed that few studies specifically focus on the incorporation of patient safety into health education or the lack of consistency between the nursing role that students are taught in the classroom and that which they experience in clinical or community placements. The evidence suggested that an individual rather than a system approach to error remains the dominant model in the nursing programme. Nursing students and most nursing educators focus on clinical rather than system safety issues (Castel & Ginsburg 2008).

External factors, availability of implementation and management tools

Community nursing guidelines addressed by Beukes & Nolte (pp. 304–313), who focus on how registered nurses influence student nurses and teach them the value of a positive attitude, good communication and respect (the nurse as a role model). To enhance quality and professionalism in the clinical setting, key priorities must be defined with focus on the need for better working methods capable of meeting future demands for expertise, i.e., high professional competence to deal with complex patient needs, as well as more interaction between research, evidence-based knowledge, education and practice.

It has been suggested that nurses are the most appropriate professional category to promote the safety and quality agenda within health care (Richardson & Storr 2010). According to Macchi et al. (2011), an organisation should explicitly define patient safety, as well as safety and safety management models. On an organisational level, a safety management model encompasses an organisation's assumptions about safety management and improvement. On a more practical level, it defines the fundamental elements (e.g. strategy, continuous development plan as well as the organisational structure and functions) required to achieve the desired performance (Macchi et al. 2011 p. 11). The key qualities of health care (access, communication, personality and demeanour of provider, quality of medical care processes, continuity, quality of healthcare facilities and staff coordination) that influence patient satisfaction were presented by Anderson et al. (2007), p. 255). The authors concluded that communication and follow-up care are the main components of patient satisfaction. Without training it is difficult to meet such patient expectations. Teaching quality improvement and patient safety to student nurses and clinical staff requires focus on a number of learner, faculty and organisational factors (Wong et al. 2010). Patient safety management in the health services is dependent on nurses, thus the role of the nurse manager as a facilitator of evidence-based practice must be further developed. In this issue, Smith (pp. 314–326) presents a qualitative systematic review of contribution of professional doctorates to nursing practice. The suggested implication for nursing management is that the role of nurse managers requires investigation, since managers are pivotal in integration of research into practice. This is in line with my recommendations that research-based patient safety management should be integrated into health education and practice. I welcome more studies focusing on how patient safety and improvement in health care organisations can be achieved.