Healthcare governance and organizational barriers to learning from mistakes.
OBJECTIVE
The purpose of this article is to advance critical debate in relation to a very critical issue in current healthcare management--namely "patient safety". This is currently a very high profile issue. In its various guises such as clinical governance, integrated governance and healthcare governance the question of avoiding or at least minimising harm to patients is attracting a huge amount of attention. Considerable resources especially within the acute sector are allocated to the problem. But, despite the systematic attention, progress in healthcare compared with certain other sectors is slow and mistakes continue to occur. Hospital acquired infections and clinical errors have become a matter of acute public concern. Evaluations of the health service are critically influenced by adverse judgements on this dimension of care.


METHODS
The authors draw primarily upon relevant literature in order to make sense of recent empirical research in eight acute hospital trusts in the UK. The analysis, however, is relevant to healthcare systems around the world.


RESULTS
The authors reveal how the massive investment in systems, service improvement mechanisms and clinical government regimes may not in themselves be enough. One reason why they may not be enough is that there can be a problem of gaining acceptance and legitimacy. Staff may see such managers as "policing" and "interfering". There is then the danger of a vicious circle--more control but less effective control because of a feeling of alienation. The policing element is at best a final safety net not the prompt for improvement. They then identify six barriers and each is accompanied by a recommendation for its resolution.


CONCLUSIONS
There are a number of implications for practice and for systems reform, which stem from the analysis. Two main recommendations stand out: they need to be handled together. First, the traditional model of the autonomous professional needs to be challenged by subjecting clinical practice to shared clinical governance procedures. Second, and simultaneously, there is a need to attend to underlying values. There is a need to revisit the issue of underpinning values so that clinical values and system-wide/managerial values are congruent rather than separate or even in conflict. At this point, governance and leadership should come together.


CONCLUSIONS
This paper provides useful information from the literature on current healthcare management.
Storey
John
J
The Open University, Milton Keynes, UK. J.Storey@open.ac.uk
Buchanan
David
D
D001291:Attitude of Health Personnel; D003659:Decision Making, Organizational; D006740:Hospital Administrators / Q000523:psychology; D006801:Humans; D007857:Leadership; D019300:Medical Errors / Q000517:prevention & control; D009313:National Health Programs; D017009:Professional Autonomy; D011787:Quality of Health Care; D012308:Risk Management / Q000379:methods; D012941:Social Responsibility; D006113:United Kingdom