Academic journal article Australian Health Review

Variation in the Adoption of Patient Safety Practices among New Zealand District Health Boards

Academic journal article Australian Health Review

Variation in the Adoption of Patient Safety Practices among New Zealand District Health Boards

Article excerpt


Hospitals work to improve the quality of their services and the safety of their patients in the interests of achieving the best possible outcomes. Variation in hospital processes1 and quality2 remain. Further, results from studies conducted in several western countries, including New Zealand, consistently suggest that there are significant rates of adverse events in hospitals, many of which are preventable.3-6 Although a wide range of effective and practical measures, including structural changes and process improvements, have been found to improve hospital quality and safety (Q&S), there is uncertainty about the extent to which they have been adopted in New Zealand.7,8

This paper presents the results of a survey exploring the adoption of Q&S measures by the District Health Boards (DHBs) that are responsible for planning and funding health services in New Zealand. It is the first publication from a project exploring the application of modern statistical methods to the assessment of hospital performance in New Zealand.9,10 The paper also relates the adoption ofQ&Smeasures to preliminary data on hospital 30-day mortality rates (adjusted for risk factors and comorbidities) for three common acute conditions.


The Chief Executive Officer (CEO) of each DHB was contacted by mail in 2008 and asked to authorise the research. The person responsible for Q&S in the DHB was then contacted, provided with an information sheet describing the research and asked to provide data by telephone interview. If willing, he or she submitted a consent form.

Interviews were conducted with informants in 18 of the 21 DHBs. The report from Otago included Southland; Tairawhiti and Nelson-Marlborough were unable to participate. In some cases, follow-up interviews were conducted with informants suggested by the Q&S manager. Interviews were completed in 2009. The DHB Q&S managers indicated that the information they supplied applied to all hospitals in the district and independent data were not collected from satellite hospitals.

Questions included in the survey aimed to assess hospital Q&S measures at two levels: organisational level attributes and processes of care related to clinical activities. Organisational attributes were included if there was strong evidence of a beneficial effect on patient outcomes or if they were part of national policy that represented a coherent statement of best practice in New Zealand.8,11,12 Indicators of clinical quality were based on work by the US-based Agency for Healthcare Research and Quality.13 These indicators have been subjected to a robust development process, and empirical analysis has shown that they are valid and reliable measures of clinical performance across a range of settings.14-16 Measures that were included in the survey are listed in Table 1, which summarises the questionnaire.

The questionnaire was designed by the research team and was peer-reviewed by senior Ministry of Health officials, and by DHB and academic staffmembers familiar with Q&S in New Zealand before being piloted in two DHBs. Questions established the presence and characteristics of organisational attributes and clinical processes; in some cases, informants were asked to assess a policy or compliance with it using a Likert scale.

As indicated in Table 1, questions were combined into 17 domains and the domains were combined into three groups. Indices were derived for each domain, giving equal weight to each subquestion. Indices were also derived for each group, giving equal weight to each domain. The first group was hospital structures and policies, the second was general clinical processes and the third was disease-specific protocols.

An overall score for each DHB was calculated, and scores across domains and groups were correlated with the degree to which the use ofQ&Smeasures in one domain or group by aDHB predicted their use in others. …

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