Academic journal article Australian Health Review

Quali-Quantitative Analysis: A New Model for Evaluation of Unusual Cases in Hospital Performance?

Academic journal article Australian Health Review

Quali-Quantitative Analysis: A New Model for Evaluation of Unusual Cases in Hospital Performance?

Article excerpt


This paper aims to provide hospital administrators and others making decisions about hospital error funding, as well as researchers, with information about what good hospital error research looks like. It offers a selective review of how the error literature has approached hospital error, which is used to develop five criteria for sound hospital error research. It also explores the potential for better hospital error research of quali-quantitative analysis (QQA), an innovative social sciences research method. In a context in which other methodologies all have their shortcomings, QQA appears to go some way toward meeting the five criteria for sound hospital error research. Ideally, QQA would be used in combination with other approaches to answer the kinds of questions that are important to hospital administrators when they are faced with high-stakes error evaluation situations.

Aust Health Rev 2007: 31 Suppl 1: S86-S97

CONSIDERABLE MEDIA AND POLICY attention is given to the high stakes "unusual cases" (such as error and/or professional misconduct) in hospital service delivery. But how can hospital administrators and policy decision makers prevent such cases from happening in the first place? This paper describes the research methods that have been used to understand hospital error. It also explores the potential of a transdisciplinary research method (quali-quantitative analysis [QQA]) for understanding hospital error and its causes, particularly in small-N studies.

Without sound practices for investigating and preventing errors, the most accurate and full error reporting systems are meaningless. Knowledge about what works and what doesn't in error research methodology is critical to managing error. Accordingly, this paper aims to provide information and criteria for deciding on the kind of study of hospital error likely to deliver sound evidence for policy and practice. The paper should also be of interest to researchers of hospital error interested in questions of research technique.

This paper does not provide a systematic review of the hospital error literature, but identifies papers that are illustrative of the methodological issues. This is why there is not an extensive discussion of the content of the hospital error literature, including the admirable work on error modelling and error management in Reason's writings, except insofar as it illustrates the methodological practices of this particular research field.


The paper has two parts: a consideration of methodological issues in hospital error research; and an exploration of QQA, an innovative research method. The first part uses discussion of methodological issues in the error literature to develop a set of criteria for quality hospital error research. This section explores the broad strengths and limitations for error analysis of common research approaches. For this part of the paper two kinds of PubMed searches were conducted on publications dated 2001-2006 using the search terms "hospital error", ie, searches of:

* 1160 abstracts and titles of publications to identify 210 possibly relevant papers

* 65 abstracts and titles of systematic reviews to identify 25 possibly relevant papers.

Bibliographies of all such possibly relevant papers were scanned to identify any other publications of interest. The contents pages of relevant journals were also scrutinised. The aim of these searches was not to offer an exhaustive formal review of hospital error research but rather to identify the "big" methodological issues characterising this literature, as a basis for defining what quality error research should be able to do.

The inclusion and exclusion of papers was informed by a broad definition of hospital error as "the failure of a planned action to be completed as intended ... or the use of a wrong plan to achieve an aim"; as well as "an unintended act, either of omission or commission, or an act that does not achieve its intended outcome"1,2 in a hospital service setting. …

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