The selected peer-reviewed article is the qualitative research study devoted to the investigation of patient safety and methods aimed to minimize medical error. “Patient safety” by T. B. Welzel was published in the professional journal, Continual Medical Education, in 2012. The paper was located through Academic Search Complete – a wide database that stores a vast number of professional and scholarly papers. The credibility and professionalism of the informational source indicate at the high scholarly value of the selected paper and support the validity of the research findings.
According to the statistical data, over 90 000 Americans die due to medical error annually (Welzel, 2012). The figure makes it clear that the research of relationships between patient safety and medical error issues play an important role in the movement for the improvement of the adverse situation in health care. Consistently with this perspective, Welzel (2012) investigates the methods and systems which can help care providers and hospital administrators to eliminate medical error and decrease the frequency of patient harm.
The identified problem has many social implications, and the high rates of patient harm due to medical error interfere with the development of social welfare and well-being. As mentioned by Welzel (2012), “around 10% of all patients entering hospitals are harmed in one way or another, and 2% die because of a medical error” (p. 406). Comparing to other high-risk industries including aviation and chemical production, medicine is associated with significantly higher rates in harming customers. Therefore, the research of new effective methods for the improvement of service quality and minimization of risks is of great interest and importance for medical practitioners.
Purpose and Research Questions
The purpose of the study is the promotion of safety culture and identification of methods which can be implemented in order to improve patient outcomes. The author also investigates the factors contributing to the adverse events primarily focusing on the developing countries as he argues that the medical error rate in developing countries is much higher than in the developed ones, and suggests that 8.2% of patient harm per admission reported in the official documents is likely underestimated (Welzel, 2012).
The questions put forward in the study are as following:
- What benefits can be gained through the consideration of patient safety?
- What is patient safety?
- What is culture of safety?
- How the principles of safe medical care can be enforced?
The formulated research objectives and questions are directly related to the identified research problem. The answers to the questions help to fill the informational gap and allow the creation of a holistic picture of the issue. At the same time, through the fulfillment of the research goals including the investigation of safety culture, the author makes the contribution to the existing body of research and supports the progress in the exploration of the problems associated with medical errors and patient safety.
It is possible to say that the selection of qualitative tools and methods is appropriate for answering the formulated research questions, and the author may rely on the conclusions made in the previous professional studies because the problem of patient safety is not new to the research in medicine and, over decades, scholars and practitioners managed to develop a comprehensive informational pool. However, when implementing the qualitative research methodology, the author needs to pay attention to the quality of the reviewed materials and the overall study design in order to increase the credibility of own findings. The analysis of the located work makes it clear that the researcher considered the aspects of data validity and employed the seminal theoretic frameworks to support the introduced ideas. In this way, he significantly increases the professional value of the paper.
Both qualitative and quantitative works are included in the review of the literature. The reviewed articles were devoted to the investigation of the types and incidence of medical errors across the globe, organizational issues of patient safety, medical risk management, surgical excellence, and human error rates. The types of sources included peer-reviewed articles and books which provide sufficient and adequate information needed to build a logical argument. Additionally, the researcher used the reports published by the World Health Organization to retrieve statistical data. In total, seventeen highly credible resources were employed in the given study. The researcher used the materials published since 1991. The oldest sources are the qualitative studies, but the most recent (published in 2012) introduced statistics and quantitative data.
Welzel (2012) indicates some weaknesses of the available studies including their limited focus on hospital-based ambulatory care or community-based private practice care. “The majority of the available data are on hospital-based in-patient care” (Welzel, 2012, p. 406). However, the focus in the identified studies can be considered a rational option because the logistical and administrative aspects of in-patient care significantly vary from the ambulatory service. The author also expresses concern with the scarcity of the available data on medical error rates in the developing countries. Thus, he uses the materials primarily written by the European and American researchers.
Conceptual and Theoretical Framework
In his research, Welzel (2012) applies and analyzes two theoretical frameworks: the high-reliability theory and the normal accident theory. According to the principles of the high-reliability theory, organizational learning, decentralized authority, the presence of a high number of backup systems, and consideration of safety as major organizational and leadership priority are the critical factors of safety culture. According to the normal accident theory, the inevitability and likelihood of incidents increase proportionally to the increase in complexity and coupling of organizational activities and operations.
Traditionally the introduced theories are regarded as mutually exclusive, but Welzel (2012) suggests to look at them like at the complementary conceptions. According to his conceptual framework, the combination of these two theoretic ideas may provide a well-balanced basis for the development of organizational safety culture. Based on this, the author claims that “while each medical system should attempt to put measures in place, as suggested by the high-reliability theory, it should also recognise that one cannot make medicine inherently safe and error free” (Welzel, 2012, p. 408). Consistently with the introduced conceptual framework, hospital administrators should analyze medical errors in relation to system defects and enablers which could not efficiently prevent an error. Medical practitioners are humans and like anyone else they prone to make mistakes, but the roots of medical errors can also be in the inefficient systems and models of healthcare. The combination of two theoretic principles suggested in the paper ensures the consideration of cultural and managerial aspects of patient safety and allows the development of effective methods for the prevention of medical errors at both individual and organizational levels.
Welzel, T. B. (2012). Patient safety. CME: Continuing Medical Education, 30(11), 406-409.