Researching Patient Safety and Quality in Healthcare

A Nordic Perspective

Karina Aase, Lene Schibevaag, Karina Aase, Lene Schibevaag

• Publisher: CRC Press
• Year: 2016
• Print ISBN:
  9781472477132
• eBook ISBN:
  9781317065524
• Topic: Technology & Engineering
• Subtopic: Industrial Engineering
• Index: Technology & Engineering

Researching Patient Safety and Quality in Health Care: A Nordic Perspective is an anthology based on contributions from leading researchers on quality and safety in healthcare in the Nordic countries together with four internationally renowned patient safety authors. Research on patient safety and quality has been dominated by countries such as the USA, England, Canada, and Australia. This book addresses the current debates in research on patient safety and quality in healthcare from a Nordic perspective. What are the flavours of Nordic research within these topics? What does it add to the international research literature? This book illustrates the unique nature of researching patient safety and quality with the Nordic perspective as well as showcasing representative work. The book presents an overview of the status and evidence of international and Nordic research on quality and safety in healthcare. Four different perspectives are used to present the trends within the research field: a patient perspective, a methodological perspective, a theoretical perspective, and a clinical perspective. The book then presents the status of Nordic research in the field and displays a set of illustrative work and current research topics within the Nordic context, concluding with a discussion of the characteristic features of Nordic research on patient safety and quality in healthcare. The anthology presents an inter-professional perspective and researchers from disciplines such as medical and nursing sciences, humanities, social sciences and engineering. It is written to contribute to the patient safety cause with translational knowledge that will be useful to researchers, policy makers and healthcare managers within Nordic countries and internationally.

1	Status of Nordic Research on Patient Safety and Quality of Care
	Sissel Eikeland Husebø, Siri Wiig, Veslemøy Guise, Marianne Storm and Britt Sætre Hansen

CONTENTS

Introduction

Background

Aim and Research Questions

The Nordic Region: What Is It?

Nordic Co-operation to Promote Patient Safety and Quality

Methods

Design

Search Methods

Review Process

Analytical Framework

Results

Phase 1: Distribution between Countries, Theoretical, Empirical and Methodological Contributions

Phase 2: Current Domains of Patient Safety and Quality Research in the Nordic Setting

Domain 1 – Evaluating Progress in Patient Safety (48 Studies)

Domain 2 – Translating Evidence into Practice (58 Studies)

Domain 3 – Assessing and Improving Culture (18 Studies)

Domain 4 – Identifying and Mitigating Hazards (31 Studies)

Domain 5 – Evaluating the Association between Organisational Characteristics and Outcomes (8 Studies)

Discussion

Conclusion

Acknowledgements

References

INTRODUCTION

This chapter provides an overview of the Nordic research on patient safety and quality based on a review of the literature. Evidence is summarised and synthesised to provide suggestions for a possible future Nordic research agenda.

BACKGROUND

In an international context, large-scale system failures such as the Bristol Royal Infirmary Inquiry (Kennedy, 2001, Kohn et al., 2000), the Mid Staffordshire Public Inquiry (Francis, 2013) and investigation of critical incidents in Dutch hospitals (Behr et al., 2015) have put patient safety on the agenda (Martin and Dixon-Woods, 2014). In all cases, large numbers of patients died or suffered due to insufficient care or malpractice over time and this practice was able to continue despite regulatory systems and inspectorates being in place to detect such failures (Weick and Sutcliffe, 2003). Compared to the Nordic countries, there have not been any system failures of a similar scale. Denmark, Finland and Sweden have specific patient safety laws, while Norway has incorporated patient safety and quality dimensions into several laws and regulations. Quality improvement strategies have been in place in the majority of the Nordic countries over several decades (since 1995 in Norway, 1990 in Sweden, 1975 in Denmark and 1994 in Finland). Iceland has a national quality development plan for the health services aiming at enhancing patient safety and quality and in 2007 the authorities published the first policy on quality in healthcare services (Sigurgeirsdóttir et al., 2014). The progress of patient safety and quality research in the Nordic countries has been more sporadic and fragmented, and to date, a limited overview exists.

To our knowledge, the Nordic research literature on patient safety and quality has not been reviewed earlier, and it is therefore worth undertaking further investigation to suggest a future Nordic research agenda in the Nordic countries.

AIM AND RESEARCH QUESTIONS

The aim of the current literature review is to provide an overview of the Nordic research literature on patient safety and quality in healthcare and to suggest directions for a future research agenda.

The review questions addressed are as follows:

1.What is the current research on patient safety and quality in healthcare?

2.Which empirical fields and research methods have been addressed?

3.Which domains of patient safety and quality can be identified?

THE NORDIC REGION: WHAT IS IT?

The Nordic region consists of the countries Denmark, Finland, Sweden, Iceland, Norway and the self-governed areas of the Faroe Islands, Greenland and Åland. The total population in the Nordic region is around 26 million inhabitants (Table 1.1). The region as a whole is sparsely populated, with the exception of Denmark (www.norden.org). The health expenditure figures for all five countries in the region are shown in Table 1.1 (OECD, 2013).

TABLE 1.1
Population Based on Numbers from OECD (2013) and www.norden.org and Health Expenditure in the Nordic Countries

Country	Population in 2011 (OECD, 2013) (in thousands)	Health Expenditure per Capita 2011 (USD)	Health Expenditure as Share of GDP (%)
Norway	4.952	5669	9.3
Denmark	5.571	4448	10.9
Finland	5.388	3374	9.0
Iceland	319	3305	9.0
Sweden	9.447	3925	9.0

Source:OECD, Health at a Glance 2013: OECD Indicators, OECD Publishing, 2013. http://dx.doi.org/10.1787/health_glance-2013-en.

NORDIC CO-OPERATION TO PROMOTE PATIENT SAFETY AND QUALITY

The Nordic region has established a cross-country co-operation within health and social affairs. The co-operation falls under the responsibility of the Nordic Council of Ministers on Health and Social Affairs. The Nordic collaboration is anchored politically, financially and culturally and is an important player in a European and international context. The co-operation is based on the shared set of Nordic values, which constitutes the basis for the Nordic welfare model (Norden, 2013). The traditional image of the Nordic model is of a welfare state characterised by a large public sector that provides its citizens with generous benefits, welfare services and a social safety net (Norden, 2014). The welfare state is supported by the principles of equal opportunities and social solidarity and security for all inhabitants, regardless of gender, ethnicity, faith, belief, disability, age and sexual orientation. The welfare model promotes social rights and equal access to social and healthcare services, education and culture. This also applies to care of those who are part of socially disadvantaged and vulnerable groups in society (Norden, 2013, p. 65).

A common Nordic strategy on health and social affairs has been developed (Norden, 2013). The strategy includes the specific goal of improving patient safety and quality of health and social services. The strategy emphasises the common challenge of an ageing population with an increased need for care and advocates for experience and knowledge exchange to ensure quality.

During the past years, most hospital services in the Nordic countries have undergone centralisation processes based on a rationale of the relationship between organising, volume and quality of treatment. The strategy also focuses on Nordic co-operation to promote patient safety. Due to their size, the Nordic countries should work closer in clinical multi-centre studies to evaluate the effectiveness and safety of new diagnostic methods and treatment. The development and use of new technology and e-health is also a prioritised area (Norden, 2013). User involvement and patient perspectives are furthermore a critical part of the Nordic strategy to achieve high-quality care, and patient experiences are regularly followed up by collecting standardised national patient surveys in specialist healthcare settings (Anell et al., 2012; Holmboe et al., 2014). The extent to which these data are used to guide quality improvement and research in the clinical setting is however not clear.

METHODS

DESIGN

An integrative systematic review methodology was used (Burns et al., 2011, pp. 418–463). This involves a multi-stage strategy that includes problem ide...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Contents
• Editors
• Contributors
• Introduction
• Chapter 1 Status of Nordic Research on Patient Safety and Quality of Care
• Section 1 Perspectives on Patient Safety and Quality in Healthcare
• Section 2 Contemporary Nordic Research – Macro-Level Issues
• Section 3 Contemporary Nordic Research – Meso-Level Issues
• Section 4 Contemporary Nordic Research – Micro-Level Issues
• Appendix
• Index