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Hospital level Clinical governance Patient safety requires a team approach. Many national and international bodies, professional organisations and medical and academic health centres now realise the importance of leadership training. Motivated and well-prepare...

INCIDENTS Understanding the concepts underlying patient safety inci - dents is useful because it helps to anticipate situations that are - likely to lead to errors and highlights areas where preventative action can be taken. The problem of error can be view e...

International Since 2009, WHO has embarked on a series of global and regional initiatives to improve surgical outcomes. Much of this work has stemmed from WHO’s Second Global Patient Safety Challenge, Safe Surgery Saves Lives . One specific strategy that has b...

INTRODUCTION In recent years, increased emphasis has been placed on the study of healthcare systems to better understand the relation ship of how management and administrative systems best support clinical practice and promote quality improvement and patient...

Lean Lean improvement methodologies originated in industrial settings among frontline workers and were pioneered in Japan, - giving rise to much of the terminology used. Kaizen is the Japa - nese word for improvement. A single ‘cycle’ of kaizen activity - is ...

Learning objectives To learn: The importance of understanding human behaviour, • quality and value in healthcare delivery The importance of human factors and teamworking in • reducing and rectifying error Medical error and its de /f_i nitions, including advers...

Low- and middle-income countries Resource-poor countries share many of the aspirations and challenges of resource-rich countries; however, they also face issues that require di ff erent strategies. The probability of a patient being harmed in hospital is gre...

Model for improvement Based on the teachings of W . Edwards Deming ( Table 15.4 ), the model for improvement is a system popularised by the Institute for Healthcare Improvement that asks three ques - tions: ‘What are we trying to accomplish?’, ‘How will we kn...

Never events Many national health services and institutions now require that all incidents are managed, reported and investigated. Incidents can be defined as events that could have or did result in unintended and/or unnecessary serious harm. One subset of seri...