Variation in the adoption of patient safety practices among New Zealand district health boardsAntony Raymont A E , Patrick Graham B , Philip N. Hider B , Mary P. Finlayson C , John Fraser D and Jacqueline M. Cumming A
A Health Services Research Centre, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand.
B University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand.
C Research Centre for Health and Wellbeing, Faculty of Engineering, Health, Science and The Environment, School of Health, Charles Darwin University, Charles Darwin University, Darwin, NT 0909, Australia.
D New Zealand Guidelines Group, PO Box 10665, The Terrace, Wellington 6011, New Zealand.
E Corresponding author. Email: firstname.lastname@example.org.
Submitted: 14 December 2010 Accepted: 12 October 2011 Published: 25 May 2012
Objective. To investigate the adoption and impact of quality improvement measures in New Zealand hospitals.
Method. Structured interviews with quality and safety managers of District Health Boards (DHBs). Correlation of use of measures with adjusted 30-day mortality data.
Results. Eighteen of New Zealand’s 21 DHBs participated in the survey. Structural or policy measures to improve patient safety, such as credentialing and event reporting procedures, had been introduced into all DHBs, whereas changes to general clinical processes such as medicine reconciliation, falls prevention interventions and disease-specific management guidelines were less consistently used. There was no meaningful correlation between risk-adjusted mortality rates for three common medical conditions and related quality measures.
Conclusion. Widespread variation exists among New Zealand DHBs in their adoption of quality and safety practices, especially in relation to clinical processes of care.
What is known about the topic? There are a significant number of adverse events which may affect hospital inpatients. Many of these are preventable. In response, quality and safety processes and measures are being adopted across the sector.
What does this paper add? The paper provides a description of the frequency with which a range of processes and measures have been adopted and demonstrates that adoption of these by New Zealand hospitals is patchy and monitoring is uneven. It suggests that the measures implemented do not appear to have impacted common mortality outcomes, though the findings may reflect the limits of feasible measurement of a probabilistic system.
What are the implications for practitioners? Managers should monitor the implementation of quality and safety measures and evaluate them in terms of their direct effects.
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