Hospital governors must not leave the task of reducing medical errors to healthcare professionals themselves. In the everyday affairs of any hospital, there are too many conflicting interests, so the governors must adopt a disinterested position. This is the assertion by doctor and researcher Ian Leistikow, who will be obtaining his doctorate in this subject on Monday 20 December at TU Delft.

Five deaths a day

Every day, dozens of patients in Dutch hospitals pick up a secondary condition. It is estimated that, every day, five people die as a result of medical error. And that is not just restricted to this country. Research in various Western nations has shown that five to ten per cent of hospital patients pick up a secondary condition while they are there.

Disappointing

Although a great deal of attention is now being paid to patient safety, the speed at which improvements are being implemented is disappointing, says researcher Ian Leistikow (who is a qualified doctor). He conducted his PhD research, which included three case studies, in the University Medical Center (UMC) Utrecht.

The role of hospital governors in improving patient safety is crucial, he concludes. "The problem is that healthcare processes are, to a high degree, multidisciplinary. So you are always dealing with different groups and different interests. If you leave the topic of patient safety to the healthcare professionals themselves, there will not usually be any progress, because of all the conflicting interests. You almost always need somebody who can take a disinterested position the governors, in other words. However, the substantive knowledge should always come from the professionals."

Safety expertise

Healthcare professionals generally possess that substantive knowledge to the required degree, says Leistikow. However, he does make one exception. "Among this group, there is unfortunately little knowledge of general safety about the question of how human error occurs, for example. There is also a lack of understanding of the fact that such error is not necessarily the result of a personal error, but that the environment can also play a role."

"This understanding is much more prominent in other sectors, such as the petrochemical or aviation industries, whose operations are designed to eradicate human error (Human Factors Engineering). In that respect, the medical world can learn a great deal."

Six features

Leistikow concludes that hospital governors can take effective charge of improving patient safety through process-based management, which he believes must include six factors. Everybody involved must be able to bring input, everyone involved must be able to take part without fear of any consequences, the right level of pressure must be brought to bear in order to monitor progress, the results must be defensible in terms of their content, it has to be possible to intrinsically motivate professionals to take part, and the initiative and support must be organised by the governors.

Knowledge centre

Leistikow has been working at the UMC Utrecht on the subject of patient safety since 2002, and has been the coordinator of the Patient Safety Center since 2006.

The topic of patient safety has been a strategic theme for the UMC Utrecht since 2002. However, Leistikow has been unable to prove with hard facts that patient safety in the Utrecht hospital has improved since more attention was paid to it. "But that does not mean to say there has been no improvement, only that it is very difficult to demonstrate any improvement that there has been with hard facts."

Sources: Delft University of Technology, AlphaGalileo Foundation.