Health Governance Review Volume 30, Issue 4: Governance for patient safety

As healthcare is increasingly digitized and interconnected, medical systems are exposed to cybersecurity threats that can endanger patient health and safety. This paper examines how the convergence of safety and security risks in connected healthcare challenges the governance of medical systems safety in Europe. The analysis shows that the management of safety and security risks of medical systems requires the extension of existing governance mechanisms, including regulation, standards, and industry best practices, to combine both safety and cybersecurity in healthcare. It puts forward policy and industry recommendations for the improvement of medical systems cybersecurity in Europe, including pre-market certification and post-market monitoring and surveillance mechanisms, effective information sharing, vulnerability handling, and patch management. The paper draws comparisons with medical device cybersecurity guidelines in the United States, and with technical controls, standards, and best practices in the domain of industrial control systems security.

Scoping Review of the Occupational Health and Safety Governance in Sudan: The Story So Far

Comparative study on the strands of research on the governance model of international occupational safety and health issues

Safety governance refers to the approaches taken to minimise the risk for patient harm across an entity or system. It typically comprises steering and rule-making functions such as policies, regulations and standards. To date, governance has focused on the clinical level and the hospital setting, with limited oversight and control over safety in other parts of the health system. All 25 countries that responded to a 2019 OECD Survey of Patient Safety Governance have enacted legislation that aims to promote patient safety. These practices include external accreditation and inspections of safety processes and outcomes. Safety governance models are also moving away from punishment and shaming towards increased trust and openness. Learning from success as well as failures represents a paradigm shift in safety governance, an approach that has been increasingly adopted in OECD countries.

Communication is a way in which humans make sense of the world around them. Communication takes place as an interactive two-way process or interaction, involving two or more people and can occur by nonverbal, verbal, face-to-face or non-face-to-face methods. Effective communication is described to occur when the sender of a message sends their message in a way that conveys the intent of their message and then is understood by the receiver of the message. As a result of the communication from both the sender and the receiver of the message a shared meaning is created between both parties.Communication can therefore be viewed as a reciprocal process. In the health care literature the terms communication and interaction are used interchangeably.Communication failures between clinicians are the most common primary cause of errors and adverse events in health care. Communication is a significant factor in patient satisfaction and complaints about care. Communication plays an integral role in service quality in all service professions including health care professions.Within healthcare, quality care has been defined by the Institute of Medicine as 'care that is safe, effective, timely, efficient, equitable and patient-centred'. Patient-centered care is defined as 'care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient's values guide all clinical decisions. Patient centered-care encompasses the 'individual experiences of a patient, the clinical service, the organizational and the regulatory levels of health care'. At the individual patient level, patient-centered care is care that is 'provided in a respectful manner, assures open and ongoing sharing of useful information in an ongoing manner and supports and encourages the participation of patients and their families'. Healthcare organizations that are patient-centered engage patients as partners and hold human interactions as a pillar of their service.The deepening evidence base for principles and practice of patient-centered care has resulted in increasing recognition of, and greater focus on, the engagement of patients, and the value and benefit of patient engagement. Contemporary healthcare policy across the globe increasingly supports the engagement of patients as partners in all aspects of their own health care and also in systemic quality improvement. In 2005, the World Health Organization's (WHO) World Alliance for Patient Safety established the Patients for Patient Safety program, to improve patient safety globally in collaboration with patient advocates across the world. As a global initiative, Patients for Patient Safety 'believes that safety will be improved if patients are placed at the center of care and included as full partners'.In 2011 the United States of America Department of Health and Human Services announced its commitment of one billion US dollars of federal funding under The Patient Protection and Affordable Care Act 2010 and launched the Partnership for Patients initiative. The Partnership for Patients public-private consortium, which focuses on patient safety improvements and draws membership from federal government agencies and over 8000 health care providing organizations and individuals, views patients 'as essential partners in improving safety and quality' and 'their participation as active members of their own healthcare team is an essential component of making healthcare safer and reducing readmission'.In Australia, as part of national health care reforms to improve access to care, the efficiency of care and public transparency of the performance and funding of health services, the Australian Health Ministers endorsed the 10 National Safety and Quality Health Service Standards (NSQHSS) in 2011 and the Australian Safety and Quality Goals for Health Care (The Goals) in 2012. The NSQHSS focus on partnerships with health consumers in their own care and treatment and also in health service planning, the design of care and service monitoring and evaluation. Standard 1 - Governance for Safety and Quality, and Standard 2 - Partnering with Consumers, are required to be integrated within all of the other eight Standards.With patient safety and quality being core to the delivery of care the Safety of Care, Appropriateness of Care and Partnering with Consumers goals have been identified as the three areas that will make up the goals over the next five years until 2017. The Australian Commission on Safety and Quality in Health Care, in providing further justification for the focus on these three areas, states:The third priority area of The Goals, Partnering with Consumers, reflects patient-centered care practice by ensuring 'that there are effective partnerships between consumers and healthcare providers and organizations at all levels of healthcare provision, planning and evaluation'. Specifically, 'Consumers and healthcare providers understand each other when communicating about care and treatment and health care organizations are health literate organizations''.As healthcare focuses on providing services that are patient-centered and methods to ensure this occurs, patients' voice and experience of health care provision is increasingly being sought from an organizational quality improvement perspective. Patients are being surveyed on their healthcare experience across interpersonal areas such as being provided the opportunity by their health professional to ask questions, the level of involvement in their own care and whether they were shown courtesy, treated with respect and listened to carefully by their health professional.Surveys of patients' satisfaction with their care are now being superseded by surveys of patient experiences of care. However, current methods used to collect and use information from patients about their care is often retrospective, provides inadequate real time data and is not effective in creating action to produce change at the individual patient level. Methods which focus on including the patient and their information in real-time are considered by many to be crucial to the advancement of improved health outcomes and the reduced costs that are required of health care to be sustainable. One such method is patient-centered communication.The nurse-patient interaction is a core component of nursing science and high quality nursing care. Fleisher et al. contend that 'the main intention of communication and interaction, in the health setting, is to influence the patient's health status or state of well-being'. As a profession, nursing predominately requires communicating with, and relating to, patients at the individual level. In the hospital setting nurses undertake many of their patient related duties in a face-to-face manner with the patient at the bedside and these moments can facilitate effective interaction to occur between the nurse and the patient, which is patient-centered. McCabe et al. state that patient-centered communication as "defined by Langewitz et al. as 'communication that invites and encourages the patient to participate and negotiate in decision-making regarding their own care'.''However, qualitative studies by McCabe and Wellard et al, highlighted that nurses interact with patients only when performing administrative or functional activities and nursing 'practice was predominately task-orientated'. The outcome of these studies are supported by Maurer et al. in their report on the tools and strategies available to support patient and family engagement in the hospital setting. Maurer et al. identified that current strategies 'are not attuned to patient and family member experiences of hospitalization' and that most tools and strategies were 'more reflective of health professional and hospital views and the organization of their work'. The report identified a gap in the initiation of engagement, which is not driven by the patients and families' needs and preferences as they occur but by the 'opportunities that the hospital makes available'.McCabe et al. also argue that nurses' attending behavior, that is their 'accessibility and readiness to listen to patients through the use of non-verbal communication' requires that they have the underpinning elements of 'genuineness, warmth and empathy' all of which are components of patient-centered communication. McCabe et al. observed that 'that nurses do not always communicate in a patient-centered way'.According to Fleischer et al. 'The listening behavior in the way of listening and asking actually is the beginning of the nurse-patient communication relationship' McCabe et al. state that the lack of recognition and support by healthcare organizations of the connection and subsequent importance of patient-centered communication in the provision of high quality care has promulgated a culture averse to patient centered communication and is a significant factor in reducing the value that nurses place on providing patient-centered communication to patients.It is apparent that tensions exist between service quality and patient-centered care principles and practice. The impact of this tension on care and the patient as an individual is reflected in the literature. McCabe et al. claim that the use of non-patient-centered types of communication can negatively affect a patient's sense of well-being and security. Horvey et al. detail patient and family member experiences of not being listened to by their health care providers and describe the resulting consequences to be as severe as the death of the patient during their hospital stay. (ABSTRACT TRUNCATED)

ObjectivesInvolving patients and the public in patient safety is seen as central to health reform internationally. In England, NHS Foundation Trusts are seen as one way to achieve inclusive governance by involving local communities. We analysed these arrangements by studying lay governor involvement in the formal governance structures to improve patient safety. MethodsInterviews with key informants, observations of meetings and documentary analysis were conducted at a case study site. A national survey was conducted with all acute Foundation Trusts (n=90), with a response rate of 40% (n=36). Follow up telephone interviews were conducted with seven of these. ResultsThe case-study revealed a complex governance context for patient safety involving board, safety and various sub-committees. Governors were mainly not involved in these formal mechanisms, with participation being seen to pose a conflict of interest with the governors’ role. Findings from the survey showed some involvement of governors in the governance of patient safety. ConclusionsThis study revealed a lack of inclusivity by Foundation Trusts of lay governors in patient safety governance. It suggests action is needed to empower governors to undertake their statutory duties more effectively and particularly through clarification of their role and the provision of targeted training and support to facilitate their involvement in the governance of patient safety.

Because of the cross-domain status of labor, a characteristic of mobility is often added to individual occupational safety and health. Cooperative governance of occupational safety and health is a key issue and a difficult problem for the government. Based on health footprint perspective, evolutionary game method and numerical simulation were employed to analyze the behavioral evolutionary path and stabilization strategies employed by government for the management of occupational safety and health issues. The findings show that with respect to the governance of occupational safety and health issues, local governments that lack constraints are likely to fall into the “prisoner’s dilemma” of occupational safety and health decisions. Further analysis shows that regulation and control by central government can rapidly promote cooperative government alliances among local governments. By evaluating a form of inter-governmental occupational safety and health governance that adopts the concept of health footprint, this study presents a new model of health governance and highlights the novel possibility of developing an inter-governmental alliance for cooperative governance.

Occupational Health and Safety Governance (OHSG) is a branch of Corporate Governance by which the board directs and controls labor risks created by their own enterprise. The OHSG concept is relatively new; unlike Occupational Health and Safety Management, which is mostly related to the work of managerial ranks, OHSG deals with principles, the interests of stakeholders, and the work of directors. The paper defines the new concept, OHSG, develops an original health and safety indicator, and presents possible applications for it; as far as we are aware of, the indicator is the first proactive tool in existence to measure OHS governance. Our work is part of an ongoing research project aimed at improving health and safety standards in industry.The indicator takes into account - in its structure - the evaluation style of National Quality Awards, as a pattern to measure, by assigning points, a great number of variables. OHS Governance variables included in the indicator are grouped into areas, themes, dimensions and elements, in order to make them operative and measurable. Measurement is performed by means of a questionnaire, reproduced as an appendix. Maximum scores for each question are assigned following multiple attribute decision theory. The article concludes with reflections on the measurement problem in the social sciences and final thoughts on the characteristics of the proposed indicator.

Workplace accidents often stem from worker negligence, human error, and insufficient management, including substandard occupational health and safety measures. Case studies, a common qualitative research method, utilize interviews and observations for primary data collection. In a specific case study at Hotel Ros-In, Yogyakarta, the Human Resources Manager was the key informant, participating in a 60-minute interview with three sub-themes: Covid-19 Post-Pandemic Regulation, Occupational Health and Safety, and Environmental Health. During the interview, Ros-In Hotel exhibited a robust commitment to complying with Ministry of Tourism and Creative Economy guidelines on hygiene, health, safety, and environmental sustainability. In the industrial sector, effective health and safety governance is crucial for maintaining consumer confidence and ensuring facilities meet stringent standards, protecting both consumers and workers. Strong safety protocols actively reduce workplace accidents and occupational diseases, fostering a safer work environment. This commitment not only benefits employees' well-being but enhances the company's overall reputation. Companies like Ros-In Hotel, through adherence to regulatory guidelines and robust safety measures, play a vital role in establishing a secure working atmosphere, instilling confidence in consumers and the broader community.

Objective: While internal audits are widely used, insight into the essential components of the internal audit to govern patient safety is limited. The aim of this study is to explore factors that hinder and stimulate internal audits as an effective patient safety governance tool for hospital boards.Methods: A qualitative interview study in six Dutch hospitals. Interviews (n = 43) were held with auditees, quality officers, boards of directors and boards of supervisors. Data were collected and analysed using Grounded Theory.Results: Barriers and facilitators were classified into 14 categories from which four themes emerged: (1) board positioning of audits, (2) organisation and content of audits, (3) competences and composition of audit team, and (4) cultural factors and attitudes towards auditing.Conclusions: We found two themes consisting of factors related to the audit itself (organisation and content of audits, and competences and composition of audit team) and two themes consisting of contextual factors (board positioning of audits, and cultural factors and attitudes towards auditing). These may contribute to support for auditing and to the generation of reliable audit results, which subsequently could result in effective audits for governance of patient safety. Hospital boards and executives can optimise the patient safety auditing system in their hospitals by increasing active leadership engagement, by promoting audits as an opportunity for staff to learn from safety problems (rather than a mandatory examination instrument) and by providing vital resources for a smooth audit process, such as a medical specialist in the audit team.

ObjectivesTo systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility.DesignA systematic review of the literature.MethodsPubMed, EMBASE, Cumulative Index...

The purpose of this paper is to present a description of the Irish national clinical governance development initiative and an evaluation of the initiative with the purpose of sharing the learning and proposing actions to activate structures and processes for quality and safety. The Quality and Patient Safety Division of the Health Service Executive established the initiative to counterbalance a possible focus on finances during the economic crisis in Ireland and bring attention to the quality of clinical care. A clinical governance framework for quality in healthcare in Ireland was developed to clearly articulate the fundamentals of clinical governance. The project plan involved three overlapping phases. The first was designing resources for practice; the second testing the implementation of the national resources in practice; and the third phase focused on gathering feedback and learning. Staff responded positively to the clinical governance framework. At a time when there are a lot of demands (measurement and scrutiny) the health services leads and responds well to focused support as they improve the quality and safety of services. Promoting the use of the term "governance for quality and safety" assisted in gaining an understanding of the more traditional term "clinical governance". The experience and outcome of the initiative informed the identification of 12 key learning points and a series of recommendations The initial evaluation was conducted at 24 months so at this stage it is not possible to assess the broader impact of the clinical governance framework beyond the action project hospitals. The single most important obligation for any health system is patient safety and improving the quality of care. The easily accessible, practical resources assisted project teams to lead changes in structures and processes within their services. This paper describes the fundamentals of the clinical governance framework which might serve as a guide for more integrative research endeavours on governance for quality and safety. Experience was gained in both the development of national guidance and their practical use in targeted action projects activating structures and processes that are a prerequisite to delivering safe quality services.

The governance of patient safety is a challenging concern for all health systems. Yet, while the role of executive boards receives increased scrutiny, the area remains theoretically and methodologically underdeveloped. Specifically, we lack a detailed understanding of the performative aspects at play: what board members say and do to discharge their accountabilities for patient safety. This article draws on qualitative data from overt non‐participant observation of four NHS hospital Foundation Trust boards in England. Applying a dramaturgical framework to explore scripting, setting, staging and performance, we found important differences between case study sites in the performative dimensions of processing and interpretation of infection control data. We detail the practices associated with these differences ‐ the legitimation of current performance, the querying of data classification, and the naming and shaming of executives – to consider their implications.

Safeguarding labour in distant factories: Health and safety governance in an electronics global production network

Anaesthetists will be the first specialists in England to have their own reporting system for patient safety incidents, the government's safety agency has announced. The new system, which is due...