EFFECT OF SAFETY AND RISK MANAGEMENT IN HOSPITAL ENVIRONMENT

(A STUDY OF TOLU MEDICAL CENTER, APAPA, LAGOS)

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CHAPTER ONE

INTRODUCTION

1.1  BACKGROUND TO THE STUDY

The risk of adverse outcomes which accompanies admission to hospitals has often been overshadowed by the promise and hope of restoration of health. The list of nosocomial complications is multifarious and includes adverse drug reactions, complications of diagnostic procedures and surgery, transfusion reactions, infections, falls from hospital beds, slippery floor, burns and irradiation injuries. Consequences of the nosocomial complications range from minor, temporary injuries to chronic, irreversible disability and occasionally to death. Aside from the personal consequences of injury to the patient, there is also an added burden of increase cost to the hospital industry and to the society.

According to Massanari (1987) it is estimated that among 23 different industrial groups, the ˜hospital’ industry was second only to ˜construction’ in the industry “ wide cost of injury as a percent of revenues in 1980. The critical issues of patient safety and medical treatment errors have received as great deal of attention lately in developed countries. Policy makers, caregivers, health care administrators and researchers have generally agreed that medical treatment error in the health care system poses a serious problem (Chassinand Galvin 1998;Leape, 2002). The hazards of hospitalization received little attention until increased public awareness of nosocomial injuries brought pressure on the hospital industry, primarily through the legal system. A plethora of successful malpractice suits has resulted in astronomical increase in the cost of liability insurance premiums leading to risk management through legislation.

In developing parts of the world with Nigeria inclusive, this problem has been relatively unexplored. Safety in organizations in general is defined as freedom from accidental injury. (Perrow, 1984; Roberts, 1990) and it is related to the safety of employees and other organizational stakeholders such AS the customers. The customers are the patients and the patient safety refers to the avoidance, prevention and amelioration of adverse outcomes including errors and accidents caused by medical actions( in contrast to disease complications), events that result from equipment failure, failure to complete a planned action as intended for example; surgical events, events involving devices,patient protection and cure) or the use of the wrong plan to achieve an aim (Talkatz-Naron, Naveh and Stern, 2005).

Traditionally, to ensure safety performance ,organizations have responded with safety rules and procedures. The premise has been that to ensure safety and avoid the costs of adverse events, organizations should invest in the implementation of formal safety programs and risk management  system (Brunson Jacobson et al; 2000; Roberts 1990).

According to Amori,Hendel and Popp(2007), in the last decade there has been a growing awareness that errors and failures in the delivery of health care are far more common and serious than the recipients, providers and funders of health care would like, it seems that at least one in 10 admissions to acute care hospital is associated with some iatrogenic harm. There has been some debate about the accuracy of these estimates, still, observational studies have confirmed that things do go wrong with very alarming frequency. There is widespread confusion, with some health services having patient safety officers, risk managers, quality improvement practitioners, nosocomial infection unit, epidemiologists and more with as many as 15 different reporting and/or management systems all doing essentially the same thing but using different paradigms.

There is no single source of information that can provide a comprehensive picture of the safety and quality of healthcare and existing sources “many rich in information“are not systematically exploited to provide structured information that is useful for finding out about what is actually being done or how and why things go wrong. It is necessary to know theseif we are to move towards delivering ˜best practice’ health care and devise effective preventive and corrective strategies for things that go wrong (Martin and Federico, 2006).

An integrated framework is needed that can operate across the entire spectrum of health care from local to national and a full range of administrative arrangements is needed. These includes the conventional medical records and ancillary information about patients, investigations and procedures, a system for logging, managing and monitoring progress when things do go wrong, a data repository for collating information from all available sources and a risk management framework underpinning both proactive and reactive responses. Central to this is a comprehensive universal classification supported by a system for eliciting, capturing and analyzing the information needed to improve the safety and quality of health care (Nadzam, Atkins and Waggoner, 2005).

1.2 STATEMENT OF THE PROBLEM

The number of patients that acquire infections and injuries in a health care setting and the number of death resulting from those infections is very alarming. The nosocomial infection has become a global problem; it is seen in the United States, United kingdom, Asia and Africa. The Center for Disease Control and Prevention (CDC)has estimated that nearly two million patients develop an infection in the United States hospital annually, approximately 90,000 of those patients (mostly infants or seniors)die as a result of their infections (Patrick, 2009).

In Nigeria, it has become a big problem commonly seen occurring in primary health care settings, in the comprehensive and general hospitals with the tertiary institutions (Teaching hospitals) not being exempted. The major hazards existing which have made nosocomial infections and injuries a big problem in the Nigerian set up have been recognized to include;

1.  Lack of amenities of adequate quality (poor hygiene, poor hospital food), inadequate medical equipment and manpower to attend to the teaming population of patients, with resultant exposures to infections.
2. Poor hospital building design, slips, trips, and falls in the hospital environment and premises (which affect all hospital users; staff, patient relatives, visitors and patients).
3. Occupational hazards from lifting and repetitive tasks by the staff, occupational violence and risks associated with poor design of the workplace. These can lead to infections such as hepatitis,needle stick pricks leading to H.I.V infection (Human Immunodeficiency Virus), pneumonia and other chest infections. Musculoskeletal injuries such as head and neck injuries,stress and serious injuries such as fractures, slipped disc from exposures to heavy lifting ,occupational violence, acute traumatic injury and even death.
4. Public sector hospitals in developing countries like Nigeria are grossly understaffed, poorly managed with increasing statistics of risk.
5. Lack of adequate funding is another hindrance with resultant disastrous consequences on the safety of the hospital environment.

However, it is important to point out that fearfully, the effects that the lack of safety and risk management parameters poses to the hospital customers (patients) and staff alike has not really been much researched into in Nigeria. This study is one of the first of its kind which is devoted to the identification, analysis and control of hospital hazards. Very few related studies have been done. In recent decades, a litigation-conscious society, concern for quality care and increasing bureaucratic intervention into health care have focused attention on hazards of hospitalization in developed countries. In developing countries on the other hand,no attention is yet to be focused on the devastating effect of poor risk management associated with our hospital environment.

1.2  OBJECTIVES OF THE STUDY

The study examines the effect of safety and risk management in hospital environment. The researcher intends to find out;

1. The effect of safety and risk management on patient survival and wellbeing in hospital environment.
2. The effect of inadequate medical facilities on patient survival in a hospital environment
3. The influence of understaffing on patients survival
4. The effect of the design of a hospital workplace on workers and patients health
5. The impact of hygiene on patients on patient health

1.4    RESEARCH QUESTIONS

1. How does safety and risk management affect patient survival in hospital environment?
2. How do inadequate medical facilities affect patient survival in hospital environment?
3. What are the effects of understaffing on patients survival?
4. How does the design of hospital workplace affect workers and patient health?
5. What is the impact of hygiene on patient health?

1.5    RESEARCH HYPOTHESIS

The hypothetical statement of the study is buttressed below:

H_o:   Safety and risk management does not have any effect on patient survival in hospital environment.

H₁:    Safety and risk management does have any effect on patient survival in hospital environment

1.6  SIGNIFICANCE OF THE STUDY

The significance of the study is stated below:

This study is one of the first of its kind in Nigeria setting. Hence, the Ministries of Health may use findings from the study to understand various factors affecting patient safety in hospital environment and generations from the findings of the study can be used to proffer solutions to how these conditions can be improved.

The study will serve as a guide to doctors, board of hospitals, Health Service Commissions, Medical Directors, Health Facility MonitoringInspectorate, Accreditation Agencies, private hospitals and clinic owners, maternity and Convalescent homes, Medical students and nurses to realize the risk involved in the poor management of a hospital environment.

Again, it will enable healthcare centers to be able to plan systematically for staff retention and this will enhance patient safety, other stakeholders of health; medical students, nurses, doctors, paramedics, laboratory scientist, donors, will use the findings of the study as a checkpoint to happenings of the same nature.

The likelihood of permanent disabilities from injuries, possibility of longer hospital stayadmissions, and the additional unwarranted cost burden from exposure to risk factors will be exposed from this study. Hence, how best to improve these problems can be discovered.

This study is quite significant in the sense that it will be useful to educationists, inspectors, health care providers, health administrators and students in order to throw more light on and expatiate further areas on how to improve safety and risk management that aids patient survival in hospital environment.

1.7  SCOPE OF THE STUDY

The work examines the effect of Safety and Risk management in hospital environment with a view to explore Tolu Medical Centre, Apapa, Lagos.

1.8  OPERATIONAL DEFINITION OF TERMS

Hospital: Hospital is an institution providing medical and surgical treatment and nursing care for sick and injured people.

Environment: The aggregate of human beings, things, conditions or influence surrounding human beings; it is all of the many physical, socio-cultural, socio-economic and physical and psychosocial factors that influence or affect the lives and survival of people.

Risk Management:  The constellation of activities; planning, organizing, directing, evaluating and implementing “ which are involved in reducing the likelihood of a negative event occurring and of injury to patients and employees, as well as property damage or financial loss in a health care facility.

Safety Management:   Organized efforts and procedures for identifying workplace hazards and reducing accidents and exposure to harmful situations and substances.

Nosocomial: Pertaining to a secondary disorder associated with being treated in a hospital but unrelated to the primary condition of the patient.

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