A Comprehensive Approach to Identifying Intervention Targets for Patient-Safety Improvement in a Hospital Setting

Abstract

Despite differences in approaches to organizational problem solving, healthcare managers and organizational behavior management (OBM) practitioners share a number of practices, and connecting healthcare management with OBM may lead to improvements in patient safety. A broad needs-assessment methodology was applied to identify patient-safety intervention targets in a large rural medical center. This included a content analysis of descriptions of managers' follow-up actions to error reports for nine types of the most frequently occurring errors. Follow-up actions were coded according to the taxonomy of behavioral intervention components developed by Geller et al. (1990). Two error types were identified as targets for intervention, and the outcome of this assessment process indicated a clear need to apply OBM interventions at the management level and thus have a hospital-wide benefit to patient safety. Future implications for using a system-wide approach to identifying and classifying responses to medical error are discussed.

Keywords:

• patient safety
• medical error
• Organizational Behavior Management

Acknowledgments

The authors are grateful to Remmie L. Arnold and Phillip A. Randall for their valuable assistance in data collection. Thomas R. Cunningham is currently affiliated with the National Institute for Occupational Safety and Health but was affiliated with Virginia Polytechnic Institute and State University during the writing of this article.

Notes

¹Results of the intervention and evaluation phases that followed the approach reviewed here are reported in Cunningham and Geller (2011)and are available upon request at [email protected].

²In this particular hospital, process-based errors were referred to as patient-safety events. Event, patient-safety event, error, and medical error are used interchangeably throughout this discussion article.

³The reporting system used at this hospital was a RiskMaster reporting system whereby employees' handwritten reports were transcribed into the electronic database by the risk management information specialist.

⁴The original form of this taxonomy (Geller et al., 1990) was selected instead of more recent versions of the taxonomy (e.g., Ludwig & Geller, 2001) because the revisions added self-initiated interventions (i.e., self-observation and self-reward), which could not be assessed through patient-safety event reports.