Document Type
Article
Publication Date
6-23-1905
Abstract
Clinical quality and patient safety are important features of contemporary medical care. Health care organizations and professionals are being urged to make significant improvements in care delivery and care outcomes; including a reduction in the risk of inadvertent patient injury associated with the care process. This study describes an opportunity to observe how a health care system and its professional staff reviewed and revised current clinical quality and patient safety programs. The intent was to better understand the attributes and mental models organizational members brought to this task and to appreciate the influence organizational structure and culture had on the effort. Using observational ethnographic methods and semi-structured interviews native views concerning these subjects and the organization's efforts to strengthen them were obtained. Structural complexity and ambiguous accountability were prominent emergent themes. Both impeded organizational improvement efforts directed at the topics of interest. The basis for the structural complexity was explored by comparing the subject organization with previously described models of organizational structure. The two organizational elements examined ( a tertiary referral and teaching hospital and an employed multi-specialty medical group ) demonstrated many professional bureaucratic features complemented by machine bureaucratic elements. Structural complexity contributed to the ambiguous accountability observed. A lack of clarity regarding the roles and responsibilities of the clinical departments where care is provided and the quality support departments also contributed to this uncertainty. Another factor, the professional culture associated with the physicians working in the organization, influenced issues of accountability and responsibility. As a group physicians have been ambivalent regarding the adoption of continuous quality improvement methods applied to the clinical care process. While there are several potential explanations for this behavior it is suggested that medical education, with its emphasis on independent decision-making and professional autonomy, may be a contributing factor.
Keywords
medical care
Rights
© The Author(s). Kelvin Smith Library provides access for non-commercial, personal, or research use only. All other use, including but not limited to commercial or scholarly reproductions, redistribution, publication or transmission, whether by electronic means or otherwise, without prior written permission is strictly prohibited.
Department/Center
Design & Innovation
Recommended Citation
Deegan, Michael J., "The Pursuit of Clinical Quality and Patient Safety: Challenges Presented by Bureaucratic Structures, Organizational Complexity and Professional Ethos" (1905). Student Scholarship. 477.
https://commons.case.edu/studentworks/477