Academic journal article New Zealand Sociology

The Challenges of Risk Control in New Zealand Public Hospitals

Academic journal article New Zealand Sociology

The Challenges of Risk Control in New Zealand Public Hospitals

Article excerpt


Unintended medical harm is an international problem with a long history. The traditional antidote to error in medicine was self-reflection in private and hard work to perfect individual skills. Empirical analysis and outside inquiry into causation were neglected (Sharpe, 2000). Although this approach was not unchallenged, its impact - until the late 1970s at least - was an absence of evidence of both the dynamics and the pervasiveness of patient harm.

Contemporary ambitions to improve safety can be traced to the emergence in the 1970s of epidemiological research counting patient harm (Mills, 1978) and human factors research into causes such as human cognitive failures, equipment design and organisational systems (Cooper, Newbower, Long & McPeek, 1978). These approaches were central to the ground-breaking efforts of the Institute of Medicine (IOM) to end the "silence" and "inaction" surrounding medical harm by highlighting its toll of human death and advocating possible solutions (Kohn, Corrigan & Donaldson, 2000, p.3). Public shock about the IOM finding that there were as many as 44,000 to 98,000 annual preventable deaths in American hospitals stimulated political action. Other countries followed shortly after and safety became a global priority in healthcare.

Safety entered healthcare policy in New Zealand (NZ) less than two decades ago through the National Strategy for Quality Improvement (Minister of Health, 2003a, 2003b). But initially the District Health Boards did not prioritise safety (Gauld, 2009) and managers and clinicians, who were expected to work cooperatively to improve it, were increasingly disengaged from one another (Ministerial Task Group on Clinical Leadership 2009). Further effort was proposed by a Ministerial Review Group (2009), briefed to address the growing fiscal unsustainability of healthcare in NZ, which identified safety as a substantial cost savings opportunity. Research showed that 12.8% of patients in public hospitals in NZ in 1998 suffered an adverse event and 14.7% of harms caused permanent disability or death (Davis et al., 2001). The diversion of scarce resources to additional treatment meant that 20% of public hospital expenditure was consumed by treating preventable adverse events (Brown et al., 2002).

International experiences with safety improvement reveal both stagnation and optimism. Although progress has been "frustratingly slow" (Leape et al., 2009, p.424) and safety has gained a reputation as a complex "wicked problem" without easy solutions (Braithwaite, Runciman & Merry, 2009, p.37), recent advances in the identification of safer practices suggest that "decisive action" is now possible (Wachter, Pronovost & Shekelle, 2013, p.350). Progress, however, is not inevitable, especially when hospitals are financially pressured. In the disaster at Mid-Staffordshire National Health Service (NHS) Foundation Trust, an excessive emphasis on financial targets enabled "conditions of appalling care ... to flourish" (Francis, 2013, p.7). The death rate was unusually high and patients' basic needs were neglected. There was a multitude of failures throughout the pathways of emergency, medical and surgical care. Work was conducted in an atmosphere of chaos due to shortages of staff, equipment and expertise, and deficiencies in communication, teamwork and learning (Healthcare Commission, 2009).

This article responds to the need to improve safety by reporting the challenges of risk control for clinical staff in NZ public hospitals. To my knowledge there is no published research about patient risk in NZ from this perspective. There are four parts to the discussion. First, literature about harm is reviewed. Second, the objectives and methodology of the research are outlined. Third, the findings of 37 qualitative interviews with nurses, doctors, and managers are summarised. Fourth, some conclusions are drawn about current risks to patients in NZ. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed


An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.