The way NHS hospital services in Wales are structured and managed locally could be a reason why measures to reduce cases of hospital acquired infections and unnecessary deaths do not always work, a major Cardiff University study aims to uncover.
Experts in organisational management from Cardiff Business School will embark on a three-year study to establish why measures to improve patient safety work better in some parts of the country than others.
“It’s estimated that one in ten NHS hospital patients are harmed during their care,” according to Professor Martin Kitchener from Cardiff Business School, an expert in the organisational analysis of healthcare.
“Along with the human costs, safety incidents are a drain on NHS resources costing an estimated £3.5 billion a year in additional bed days and negligence claims.
“We already know that, as a result of increased public awareness, patient safety is top of the public and political agenda and, as a consequence we’ve seen a series of improvement programmes introduced to improve patient safety.
“However, we also know that outcomes are patchy as a result of the ways hospitals are structured, their culture and differing managerial priorities.
“This study will help establish, for the first time, the evidence we need to understand why we have differing outcomes for patients in different parts of Wales and help take action to address them.”
The research team from Cardiff Business School has been awarded a £330,000 grant by the National Institute for Health Research Service Delivery and Organisation Programme (NIHR SDO). The study will examine features of organisation and management associated with the successful local implementation of a national hospital patient safety programme.
Professor Kitchener said: “Recent studies have found that many safety interventions fail to deliver the expected improvements because of unanticipated organisational features such as inappropriate organisational structures and competing managerial priorities.
“It shows that outcomes of NHS patient safety innovations vary across hospitals demonstrating that the organisational context of their implementation matters.”
This study will combine insights from organisational theory within realist analysis to examine relationships between aspects of organizational context and health outcomes in the Welsh national 1000 Lives + patient safety programme.
Specifically, the study will combine existing health outcome data with new primary data on context to examine the introduction of three safety interventions: improving leadership, reducing infection rates, and implementing surgical checklists.
The primary goal will be to identify which contextual factors matter, how they matter, and explain why they matter in order that processes and outcomes may be improved.
During the first year, the study will interview programme leaders, clinicians, nurses and managers at nine case hospital sites and include hospitals that exhibit variation in organizational features suggested to influence performance including size, complexity, rural/urban areas.
In year two, after initial data analysis, four main study sites will be selected for detailed study, including additional interviews. The primary goal will be to develop better understanding of local relations between context and performance concerning the focal interventions.
Professor Kitchener, who will lead the study, alongside experts from the University of Nottingham and Auckland University added: “The study will help us develop an evidence-base to improve efforts of policy makers and managers locally, nationally, and internationally.
“We aim to develop a model which could act as a diagnostic tool for new patient safety interventions in future. Crucially, we hope our findings will help NHS services across the country to develop improvement interventions that are more likely to ‘work’ in their local, contingent circumstances.”
The study is set to begin in October and is expected to be completed in 2014.
