Journal of Patient Safety and Risk Management

Amid longstanding recognition that healthcare challenges are often managerial, not just clinical, many have called for greater attention to developing physicians’ business management abilities. However, the Covid-19 pandemic has amplified the urgency of building physicians’ business knowledge and skills—from understanding health economics and finances to managing dynamics of collaborative leadership and change—in order to respond to pandemic-induced business challenges that threaten healthcare organizations. Unfortunately, existing efforts to develop these critical skills among physicians remain limited, focusing primarily on early-career physicians-in-training or later-career physicians in formal leadership positions. These efforts leave a wide swath of frontline physician leaders “in the middle” without systematic resources for developing their business management abilities. We advocate for several key changes to professional practices and policies to help bring business of health knowledge and skills to the foreground for all physicians, both in the pandemic and beyond.

Healthcare providers commonly experience risky situations in the provision of maternity care, and there has been increased focus on the lived experience in recent years. We aimed to assess opinions on, understanding of and behaviours of risk on the LW by conducting a mixed methods study.

Staff working in a LW setting completed a descriptive questionnaire-based study, followed by qualitative structured interviews. Statistical analysis was performed with SPSS on quantitative data and thematic analysis performed on qualitative data.

Nearly two thirds of staff (64%; 73/114) completed the questionnaire, with 56.2% (n = 47) experiencing risk on a daily basis. Experiencing risk evoked feelings of apprehension (68.4%; n = 50) and worry (60.2%; n = 44) which was echoed in the qualitative work. Structured clinical assessment was utilised in risky situations, and staff described “going on autopilot” to manage these situations. A large number of respondents reflected on their provision of care following an adverse event (87.7%; n = 64). Debriefing was mentioned as an important practice following such events by all respondents.

This study describes the negative terminology prevailing in emergency obstetric care. These experiences can have a profound impact on staff. Risk reduction strategies and the provision of increased staff support and training are crucial to improve staff wellbeing in stressful scenarios.

Patient safety, staff moral and system performance are at the heart of healthcare delivery. Investigation of adverse outcomes is one strategy that enables organisations to learn and improve. Healthcare is now understood as a complex, possibly the most complex, socio-technological system. Despite this the use of a 20th century linear investigation model is still recommended for the investigation of adverse outcomes. In this review the authors use data gathered from the investigation of a real life healthcare near incident and apply three different methodologies to the analysis of this data. They compare both the methodologies themselves and the outputs generated. This illustrates how different methodologies generate different system level recommendations. The authors conclude that system based models generate the strongest barriers to improve future performance. Healthcare providers and their regulatory bodies need to embrace system based methodologies if they are to effectively learn from, and reduce future, adverse outcomes.

Root cause analysis (RCA) is a recognised approach to understanding causation of adverse events across high-risk industries including healthcare. These methodologies were developed during the early part of the twentieth century when the workplace could be understood as a series of linear processes. Within a complex system these approaches offer limited insight, which has since been recognised within healthcare literature. This paper proposes an approach to understanding of causation that addresses Hollnagel’s ‘hypothesis of different causes’ and integrates Safety I and Safety II approaches. This develops Stretton’s Lilypond Model to conceptualise the relationship between work-as-imagined and work-as-done within a complex system where individual adaptations and variations can be analysed. Understanding variation in such a way creates a shift in methodology from a deterministic to a probabilistic approach, which is more appropriate for understanding causation within complex systems.