Klinisches Risikomanagement im Spital aus organisationspsychologischer Perspektive

Abstract

Patient safety is a central theme in health care and is the foundation of good patient care. But especially in complex organizations, such as hospitals, risks can never be ruled out completely, at best they can be minimized. For example, several studies show that adverse events happen to between 3.7-16.6% of patients admitted to hospitals. At least half of these are preventable. In the case of severe outcomes, such events lead to tragic personal fates and also generate high economic costs. Although research and knowledge on patient safety have increased rapidly over the last decade, little proof has been found for successful patient safety initiatives. Accordingly, enhancement of patient safety was described as the ultimate challenge for those who specialize in human factors. From an organizational psychology perspective, clinical risk management (CRM) is of critical importance, as it provides crucial support for patient safety. CRM encompasses all structures, processes, instruments and activities enabling hospitals to assess, manage and contain risks while providing clinical treatment and patient care. It frames the hospital as a system, instead of focusing on individuals and their potential for committing errors. But so far comprehensive studies on the maturity of CRM were lacking and the key elements for successful implementation of CRM remained unknown. This thesis provides several important contributions. The main goal was to gain an empirical basis for the implementation of CRM in hospitals. The first part was methodological. A monitoring instrument for assessing CRM was developed based on a literature review and expert interviews. To evaluate the maturity of different aspects of hospitals’ CRM a scale was adapted from a psychological model. This supports hospitals in designing and implementing of interventions tailored according to their maturity. At a national level, the results of a systematic monitoring can be used to establish transparency, support change, and coordinate different CRM related programs. Secondly, three key enablers for CRM were identified: implementing a position for central CRM coordination, assuring dialogue with the different hospital services and developing strategic CRM objectives. These elements can be used independently of other conditions, such as hospital size, type or formal body. This provides an empirical basis for optimizing CRM and can be used to promote patient safety. And thirdly, specifics of CRM in mental health care were investigated. A systematic overview of main risks and related management practices was provided based on empirical data. This helps facilitating a proactive treatment and mastering of risks in mental health care. This is an important step to improve safety also for patients with mental illnesses who are extremely vulnerable, as so far in the literature little understanding of systematical CRM in mental health care could be found.