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The Boundaryless Hospital Through Risk Management Approach: A Case Study of the A&E Unit of a Tertiary-Care Hospital in Malta

  • Sandra C. ButtigiegEmail author
  • Dorothy Gauci
  • Prasanta K. Dey
Chapter

Abstract

Over the years, several scholars and policy makers have attempted to provide solutions to minimize risk in health care, and consequently improve patient safety. Possible solutions are to have parts of the health services better integrated, as well as to optimize resources safely through risk management principles. Twenty years ago, Braithwaite and colleagues discussed the future of the hospital and coined the term boundaryless hospital (Braithwaite et al., Aust NZ J Med 24(5):565–571, 1994). The authors foretell a radical change in the nature of the modern hospital with the advent of state-of-the-art information technology and innovative clinical equipment. Similarly, over the past two decades, risk management principles have been applied to health care (Dey et al., Manag Serv Qual 16(2):203–222, 2006; Liberatore and Nydick, Eur J Oper Res 189(1):194–207, 2008). Health care organizations are being tasked with doing more with less while still striving to safeguard patient safety as well as to operate at lowest levels of risk. The main aim of this research is to improve the quality of care in the accident and emergency (A&E) unit of a Maltese tertiary-level hospital through the assessment of risk and the concept of a boundaryless hospital. This study adopts a risk management framework to identify risk factors that affect the quality of care, analyze their likelihood and impact, and develop responses to mitigate those risks. Through assessment of the risks at the system level, innovative solutions can be applied to reduce boundaries in the patient care pathway.

Keywords

A&E Unit Boundaryless hospital Risk analysis Risk map Cause and effect diagram Malta Quality of care 

References

  1. American Society for Healthcare Risk Management (2010) Risk management handbook for health care organizations. Wiley, San FranciscoGoogle Scholar
  2. Ang D, Norwood S, Barquist E, McKenney M, Kurek S, Kimbrell B, Garcia A, Walsh CB, Liu H, Ziglar M, Hurst J (2014) Geriatric outcomes for trauma patients in the state of Florida after the advent of a large trauma network. J Trauma Acute Care Surg 77(1):155–160CrossRefGoogle Scholar
  3. Azzopardi M, Cauchi M, Cutajar K, Ellul R, Mallia-Azzopardi C, Grech V (2011) A time and motion study of patients presenting at the accident and emergency department at mater dei hospital. BMC Res Notes 4(1):421CrossRefGoogle Scholar
  4. Braithwaite J, Vining R, Lazarus L (1994) The boundaryless hospital. Aust NZ J Med 24(5):565–571CrossRefGoogle Scholar
  5. Buntin MB, Burke MF, Hoaglin MC, Blumenthal D (2011) The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Aff 30(3):464–471. doi: 10.1377/hlthaff.2011.0178 CrossRefGoogle Scholar
  6. Chassin MR, Loeb JM (2013) High‐reliability health care: getting there from here. Milbank Q 91(3):459–490CrossRefGoogle Scholar
  7. Cheung DS, Kelly JJ, Beach C, Berkeley RP, Bitterman RA, Broida RI, Dalsey WC, Farley HL, Fuller DC, Garvey DJ, Klauer KM, McCullough LB, Patterson ES, Pham JC, Phelan MP, Pines JM, Schenkel SM, Tomolo A, Turbiak TW, Vozenilek JA, Wears RL, White ML, Section of Quality Improvement and Patient Safety, American College of Emergency Physicians (2010) Improving handoffs in the emergency department. Ann Emerg Med 55(2):171–180CrossRefGoogle Scholar
  8. Cydulka RK, Tamayo-Sarver J, Gage A, Bagnoli D (2011) Association of patient satisfaction with complaints and risk management among emergency physicians. J Emerg Med 41(4):405–411CrossRefGoogle Scholar
  9. Dahlgaard JJ, Pettersen J, Dahlgaard-Park SM (2011) Quality and lean health care: a system for assessing and improving the health of healthcare organisations. Total Qual Manag Bus Excell 22(6):673–689CrossRefGoogle Scholar
  10. De Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA (2008) The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care 17(3):216–223CrossRefGoogle Scholar
  11. Dey PK, Hariharan S, Brookes N (2006) Managing healthcare quality using logical framework analysis. Manag Serv Qual 16(2):203–222CrossRefGoogle Scholar
  12. Dixon A, Le Grand J, Henderson J, Murray R, Poteliakhoff E (2011) Is the NHS equitable?: a review of the evidence. LSE Health and Social Care, London School of Economics and Political Science, LondonGoogle Scholar
  13. Duckett S, Nijssen-Jordan C (2012) Using quality improvement methods at the system level to improve hospital emergency department treatment times. Qual Manag Health Care 21(1):29–33. doi: 10.1097/QMH.0b013e31824180f6 CrossRefGoogle Scholar
  14. ECRI (2009) Risk management, quality improvement, and patient safety. Risk Qual Manag Strateg 2(4)Google Scholar
  15. Epstein SK, Huckins DS, Liu SW, Pallin DJ, Sullivan AF, Lipton RI, Camargo CA Jr (2012) Emergency department crowding and risk of preventable medical errors. Intern Emerg Med 7(2):173–180CrossRefGoogle Scholar
  16. Flanagan PT, Relyea-Chew A, Gross JA, Gunn ML (2012) Using the internet for image transfer in a regional trauma network: effect on CT repeat rate, cost, and radiation exposure. J Am Coll Radiol 9(9):648–656CrossRefGoogle Scholar
  17. Frisse ME, Johnson KB, Nian H, Davison CL, Gadd CS, Unertl KM, Turri PA, Chen Q (2012) The financial impact of health information exchange on emergency department care. J Am Med Inform Assoc 19(3):328–333. doi: 10.1136/amiajnl-2011-000394 CrossRefGoogle Scholar
  18. Genet N, Boerma W, Kroneman M, Hutchinson A, Saltman RB (2013) Home care across europe. European Observatory on Health Systems and Policies, LondonGoogle Scholar
  19. Hirschhorn L, Gilmore T (1992) The new boundaries of the “boundaryless” company. Harv Bus Rev 70(3):104–115Google Scholar
  20. Hoot NR, Aronsky D (2008) Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med 52(2):126–136CrossRefGoogle Scholar
  21. Hopkin P (2014) Fundamentals of risk management: understanding, evaluating and implementing effective risk management. Kogan Page, LondonGoogle Scholar
  22. Kachalia A, Gandhi TK, Puopolo AL, Yoon C, Thomas EJ, Griffey R, Brennan TA, Studdert DM (2007) Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. Ann Emerg Med 49(2):196–205CrossRefGoogle Scholar
  23. Kohn LT, Corrigan JM, Donaldson MS (2000) To err is human: building a safer health system. National Academies Press, Washington, DCGoogle Scholar
  24. Liberatore MJ, Nydick RL (2008) The analytic hierarchy process in medical and health care decision making: a literature review. Eur J Oper Res 189(1):194–207CrossRefGoogle Scholar
  25. Lowthian JA, Curtis AJ, Jolley DJ, Stoelwinder JU, McNeil JJ, Cameron PA (2012) Demand at the emergency department front door: 10-year trends in presentations. Med J Aust 196(2):128–132CrossRefGoogle Scholar
  26. McCusker J, Vadeboncoeur A, Lévesque J, Ciampi A, Belzile E (2014) Increases in emergency department occupancy are associated with adverse 30‐day outcomes. Acad Emerg Med 21(10):1092–1100CrossRefGoogle Scholar
  27. McQueen C, Crombie N, Perkins GD, Wheaton S (2014) Impact of introducing a major trauma network on a regional helicopter emergency medicine service in the UK. Emerg Med J 31(10):844–850. doi: 10.1136/emermed-2013-202756 CrossRefGoogle Scholar
  28. Muscat NA, Calleja N, Calleja A, Cylus J (2014) Malta: a health system review. WHO, Copenhagen, 2014. Health Syst Transit 16(1)Google Scholar
  29. Nolan TW (2000) System changes to improve patient safety. BMJ 320(7237):771–773CrossRefGoogle Scholar
  30. Nugus P, Carroll K, Hewett DG, Short A, Forero R, Braithwaite J (2010) Integrated care in the emergency department: a complex adaptive systems perspective. Soc Sci Med 71(11):1997–2004CrossRefGoogle Scholar
  31. Pai NP, Vadnais C, Denkinger C, Engel N, Pai M (2012) Point-of-care testing for infectious diseases: diversity, complexity, and barriers in low-and middle-income countries. PLoS Med 9(9):e1001306CrossRefGoogle Scholar
  32. Purdy G (2010) ISO 31000: 2009—setting a new standard for risk management. Risk Anal 30(6):881–886CrossRefGoogle Scholar
  33. Roberge D, Pineault R, Larouche D, Poirier LR (2010) The continuing saga of emergency room overcrowding: are we aiming at the right target? Healthc Policy 5(3):27–39Google Scholar
  34. Ruchholtz S, Lefering R, Lewan U, Debus F, Mand C, Siebert H, Kuhne CA (2014) Implementation of a nationwide trauma network for the care of severely injured patients. J Trauma Acute Care Surg 76(6):1456–1461. doi: 10.1097/TA.0000000000000245 CrossRefGoogle Scholar
  35. Rusu M, Saplacan G, Sebestyen G, Todor N, Krucz L, Lelutiu C (2011) eHealth: towards a healthcare service-oriented boundary-less infrastructure. Appl Med Inform 27(3):1–14Google Scholar
  36. Ryan PB, Madigan D, Stang PE, Marc Overhage J, Racoosin JA, Hartzema AG (2012) Empirical assessment of methods for risk identification in healthcare data: results from the experiments of the observational medical outcomes partnership. Stat Med 31(30):4401–4415CrossRefGoogle Scholar
  37. Schuur JD, Venkatesh AK (2012) The growing role of emergency departments in hospital admissions. N Engl J Med 367(5):391–393CrossRefGoogle Scholar
  38. Smits M, Zegers M, Groenewegen PP, Timmermans DR, Zwaan L, van der Wal G, Wagner C (2010) Exploring the causes of adverse events in hospitals and potential prevention strategies. Qual Saf Health Care 19(5):e5. doi: 10.1136/qshc.2008.030726 Google Scholar
  39. Tehrani AS, Lee H, Mathews S, Shore A, Frick K, Makary M (2011) 20-year summary of US malpractice claims for diagnostic errors from 1985–2005. In: 33rd Annual Meeting of the Society for Medical Decision Making, Chicago, IL, pp. 22–26Google Scholar
  40. Tunçalp Ö, Souza J (2014) Maternal near‐miss audits to improve quality of care. BJOG 121(s4):102–104CrossRefGoogle Scholar
  41. Waterson P (2014) Health information technology and sociotechnical systems: a progress report on recent developments within the UK national health service (NHS). Appl Ergon 45(2):150–161CrossRefGoogle Scholar
  42. White AA, Wright SW, Blanco R, Lemonds B, Sisco J, Bledsoe S, Irwin C, Isenhour J, Pichert JW (2004) Cause‐and‐effect analysis of risk management files to assess patient care in the emergency department. Acad Emerg Med 11(10):1035–1041CrossRefGoogle Scholar
  43. Widgren BR, Jourak M (2011) Medical emergency triage and treatment system (METTS): a new protocol in primary triage and secondary priority decision in emergency medicine. J Emerg Med 40(6):623–628CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Sandra C. Buttigieg
    • 1
    Email author
  • Dorothy Gauci
    • 1
  • Prasanta K. Dey
    • 2
  1. 1.Faculty of Health Sciences, Department of Health Services ManagementUniversity of MaltaMsidaMalta
  2. 2.Aston Business SchoolAston UniversityBirminghamUK

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