Safety and risk Management BY Ala' khdeir Amman-Jordan Email :- thirdpartner2003@yahoo.

com Introduction The existing health care plan chosen is the Jordan Health Care Accreditation 20072010. This 3 year plan stipulates the requirements and tools needed to implement a more efficient and manageable health care system based off a comprehensive planning strategy for the future of both public and private health care in Jordan (JHAP, 2006). The hospital systems in Jordan have adopted this accreditation program to evaluate the quality of care and develop its clinical practices and capabilities in order to attain the highest levels of care to patients. The healthcare framework that supports this plan is the organisation called the Health Care Accreditation Council (HCAC) (Health Care Accreditation Council, 2010). The aim of this council is to champion the continuous quality improvements for health care systems in Jordan by providing certain minimum standards of care and providing accreditation and certification for operational excellence. It also has other secondary objectives such as improving patients safety and focus on risk management and health care prevention. Another key stakeholder involved with the reforms is the United State Agency for International Development (USAID), which has been working in close partnership with the Jordanian Health Care System for a number of years. These two organisations have been instrumental in the development and implementation of the accreditation plan. The main hospital that we will be focusing on is the Prince Hamzeh Hospital, in Jordan. The functional area of the hospital systems that will be the focus of this paper is primary health care services and delivery. The plan stipulates many improvement areas and performance objectives in relation to primary health care. Currently, the plan is due to be completed this year which allows us to draw many conclusions about the current state of primary health care in Jordan and to measure the effectiveness of implementation. Safety Literature Safety involves taking a proactive approach to preventing accidents or injuries which may arise if the necessary precautions or guidelines are not followed. The accidents, errors, injuries, mistakes or deviations can potentially cause serious physical, social, spiritual, financial, political, emotional, occupational, psychological, educations, physiological losses, and a vast array of many other misfortunes. However, for all safeguards and best practices there are always limitations involved with safety compliance. Usually, this is reflected in monetary value by what things are insurable against losses, damages or harm. The concept of safety is relative and it is extremely difficult to completely eliminate all possible risk factors. There are three main types of safety : normative, substantive and perceived safety (Carroll, 2001).

 Normative safety is the compliance of products, services and designs to a set specification or standards of safety. Substantive safety- is the objectionable degree of safety, based on historical circumstance or facts Perceived safety is the subjective level of safety, based on peoples sentiments and opinions on the safety of something. There exist many international safety organisations related to health care, including the World Health Organisation, International Labour Organisation, Health and Safety Executive, etc. In most Western Nations, the standards of OH/S and safety in Health Care are extremely high and there exists very specific requirements and operating policies to be followed. This is similar to the business world, which has very tight operating controls and protocols relating to each functional component of the business (Fuller, 2004). A safety system or organisation that had built in safety mechanisms is only as good as the people who support it. This is what we define as a culture of safety; whereby a group of likeminded peoples i.e. employees, share the same beliefs and values towards a common goal. Therefore, a strong safety culture within an organisation will most definitely surpass the performance of a safety system alone. This involves an agreement between all employees about the importance and magnitude of safety aspects, identifying risks and issues with universal acceptance, and risk mitigation strategies and precautions enacted (Davies, 2004). The following health care safety framework was developed by Krause(2009) and encompasses the whole organisation. Specifically, it provides a systematic approach to the topic of health care safety and a conceptual model to apply to effective healthcare intervention strategies. <scan in pg 30 of text>. The author asserts that this framework is a combination of effective leadership, a cohesive organisational culture, well established enabling elements(such as policies & procedures, regulations, accreditations, training programmes, hazard & risk management, etc.), and strong sustaining organisational systems(such as employee incentive schemes, management and performance systems, various HRM functions, etc). Krause also informs us that organisational safety is deeply embedded in a matrix of forces beyond the individual health care organisation and therefore it is essential to take into consideration all of the external factors(such as the national legislations and regulation, cultural factors, and current demand levels). A combination of all these elements is required for a sound safety framework to be effective. The author reveals that most hazards occur at the working interface level, i.e the configuration of equipment, facilities, processes, systems and behaviours that define the interactions between patients, staff and technology. This exposure to hazard can loosely be defined as any condition, decision, behaviour, activity, cultural standard, process or system that will probably increase the probability of a patients pain, suffering, anguish, torment, and even possible death. Vincent (2009) has specified the use of clinical guidelines to support the Prince Hamzeh hospital in achieving their goals. Vincent (2009) declares that there is a strong and compelling rationale to implement these following guidelines. They

include : The appropriateness of healthcare for the context of use, managing high volumes of information where pertinent to safety culture, maximising shared information and collaborative decision making, using all methods to prevent a possible litigation cases against the hospitals for potential breaches, both major and minor. The efficiency abed effectiveness should be encouraged with an emphasis on major resource allocation and rigid criteria for superfluous expenditures. The joint accreditation certification endorsement standards for Australia and NewZealand is stipulated by JAS-ANZ(2007). They categorise these standards and protocols according to management, clinical practices, practice guidelines, personnel, and consumer/patient rights categories. Each section stipulates all of the compliance standards and requirements. It would benefit the Prince Hamzeh hospital immensely to adopt, even just a partial amount of these standards as it will allow much greater consistency, accuracy and standardisation with operational, procedural and reporting requirements of the hospital. It should be noted that these standards were developed by an independent regulatory body and are a general framework, therefore it needs to be recognised that they will need to be adopted and applied differently depending on the nature, size, scope and operations of the particular hospital. Nevertheless it provides a good framework that any hospital can adopt and start to incorporate some of these things to help improve efficiency of operations and reduce health hazards, with a particular emphasis on health and safety within the hospital environment, which is the focus of this report. Hargrave (2009) has provided a brief paper on the key OH&S compliance factors in his remarkable paper. Most of these points are related and thus applicable to the whole hospital. It is a combination of the following points which can provide tremendous support for the Prince Hamzeh Hospital in achieving their OH/S compliance and greater safety principles and practices adoptions. According to Hargrave(2009) this will involve the : Compliance with all applicable health and safety laws, regulations and standards. Providing a safe plant and equipment and work environmental extraneous factors. Ensuring all managerial compliance and identification and risk management of all hazards and risk factors with an emphasis on proactive self regulation and identification to counter these risk measures. Provision of appropriate health and safety training to all relevant personnel. Maintaining control and compliance of all policies, procedures, systems, information, training programminations, whereby to effectively support and communication of these standards. Utilise appropriate internal and external expertise when required. Establishing real targets and objectives on a biannual basis to ensure consistency and target conformance. The maintenance and running of a positive, enlightened safety culture which will encourage the active participation of all key stakeholders (e.g. doctors, professors, nurses, patient, managers, etc.) with the emphasis on collaboration and collusion of information sharing and utilisation. Effectively disseminate health care safety literature and informational evidence to all employees and other personnel who need to acquire such

materials in order to effectively carry out their roles and job functions within the hospital system. Coordinating a rapid and fast response times to all open investigations and incidents, whereby they occur at a particular point in time and taking steps to prevent future occurrences and delimit the possibility of further anomalies and breakdowns within the system. This should be supported by regular audits and control mechanisms within the hospitals safety framework and which can be carried out by the safety officer of the organisation.

Benefits of HCAC

However, the HCAC Accreditation module provides tools for health care systems to take accountabilities for improving the quality of care (Health care accreditation council, 2010). There are many benefits for using the accreditation system in health care facilities such as:

Provides a mechanism that is used in the process of quality assessments. Provides a set of health care standards in order to raise the quality of care and reduce risks. Develops and manage patients safety and related risks. Promote the process of continuous quality improvements to ensure acceptable levels of the quality of health care. Broaden the prospect of awareness and understanding of health care providers for quality of care to bring about great outcomes in the field of health care.

Help in determining patient safety issues in health care systems and how to deal with them (Health care accreditation council, 2010).

Accreditation framework This accreditation framework has tight integration with the goals and objectives of the functional area of the hospital. The process of quality improvement within organisations should be linked to particular facets or areas of the organisational structure, its capacity and suitable practices which will support the development of quality within the organisation (JHAP, 2006).

Another key area is the development of the workplace culture and HR policies as this will invariably have an impact on the performance and effectiveness of the health care system. The existence of active and motivated staff will be more inclined to deliver better outcomes and delivery of services for patients (JHAP, 2006). Other quality improvement initiatives include such factors as establishing a system to provide patients health services based on best practices and highest standards. The accreditation plan is facing many potential problems and issues that must be resolved in a timely fashion. Many of these issues are quite diverse and multifaceted, therefore a single approach will not be suitable for all of them. Potential Issues Some of the issues currently undermining and affecting the success of the plan include : The demographic changes representing increase in population and higher life expectancy. Considerable changes in lifestyles favouring the development of determinants and risk factors for chronic diseases, accidents, injuries, and substance abuse. The epidemiological transition and changes in the pattern of disease characterized by a progressive increase in the magnitude of no communicable diseases like cardiovascular diseases, cancer, diabetes, mental health problems as well as accidents and health of the elderly. Inefficiencies observed in the provision and financing of health services. The lack of a rigorous appraisal (and reorientation) of the current state of human resources development in health The negative impact of poverty on accessibility to quality health care particularly in view of the high proportion of uninsured people The increasing demands and expectations of the public for effective and accessible health care. The rapid advances in technology and rising health care costs. Inadequate coordination between the public sector and the increasingly significant private sector and the lack of effective systems for monitoring and auditing clinical practice. The emerging environmental health issues. (EMRO, 2009)

Recommendations There are many factors influencing the management of health and safety risks. Compliance with legislation and avoidance of legal liability are top management priorities for managing health risks. There are serious penalties and fines incurred for non-compliance and the stench of a tarnished reputation would be unfortunate. Economically reasoning, an organisation derives economic value from the cost plus production of its goods and services. We can enhance this by adding economic efficiencies and utilisation of maximum capital. Constraints may lead to a minimisation of operating costs and subsequently standards, which may have a negative impact on risk mitigation and safety levels (Davies, 2004). Social factors include the way socialites expectations and mounting pressures will impact on a business and their goal setting of risks incurred. We have devised a strong framework for the hospital to apply which will see a reduction in risk and increase in effectiveness and smooth operations. The outline of the framework includes the following : Standardisation and systems improvements - involves using medication charts and indicators, and various other tools for systems improvements. Reducing practice gaps assessing and improving the adequacy of current medical safety and quality activities, identify gaps in national medication safety and quality activities, and to recommend a national approach to improving the safety and quality of medicines uses (ACSQHC, 2010). Continuity of medicines management Involves the project of reconciling medication and creating standard operating protocols, designed to assure medical accuracy at transitions of care. The World Health Organisation(WHO) is leading this international project. Using Technology Utilising electronic medication management systems(EMMs) to reduce the prevalence of medication errors in hospitals. This can be accomplished by specifying and developing user requirements and procurement guidelines, implementation toolkit for hospitals, and an enhanced user interface. Advocating medication safety and quality - by working with the National Medicines Policy Executive and other organisations working in national medication safety and quality. Appendix 1 shows us the main causes and effects of mistakes from occurring in the hospital system. We can clearly see a multiplicity of errors and causations which are possible to result from this behaviour. Some of these causes are structural in nature(stems), whilst others are as a result of the structure(branches) or partially of. To complicate matters further, there may be a composite of structural and

substructural problems occurring simultaneously which is causing this, or as a result of many different factors which may not have any explicit cause or source (ACSQHC, 2010).

Conclusion The hospital systems in Jordan, especially the Prince Hamzeh Hospital(which was the focus of my exposition) must make progress in terms of standardising procedures and systems to ensure better coordination and information sharing amongst departments. A national unified approach to medical standards in Jordan would also reduce the prevalence of errors and establish a minimum benchmark or standard for practicing physicians. The continuity and consistency of medication management and administration, which has been developed by the WHO, would give the hospital higher accuracy of medication dosages and inducement. The Jordanian government can also do more, in terms of actively advocating the importance of medication safety and educating the public to raise awareness of the issue, mainly to reduce national health costs and the mortality rate, associated with medication errors. It should be remembered that proactive safety and risk management is paramount to any organisations success, which is even more so the case for health care systems as they are highly complex, diverse and dynamic in nature. Without a suitable framework and methodologies they will lack coordination and ability to be efficient and accurate in their daily workflow and operations, as we have previously seen with the old health care system, prior to making changes and improving their foundations. I would like to hope that they can maintain this newfound level of efficiency and result in continuity in operations, substantiated reduction in medical errors, and very low risk level.

Appendix

Australian Commission On Safety and Health Care (2009), Discussion Paper on Achieving the National Policies Proposed in the National Safety and Quality Framework, Website accessed on 26/10/09 from http://www.safetyandquality.gov.au/

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