A critical perspective on organisational development and patient safety in Austria.

Contrary to the international trend of building Critical Incident Reporting Systems (CIRS) into national health systems there is no national CIRS in Austrian hospitals. In response to this lack of a national policy the Austrian Association for Gynaecology and Obstetrics (OEGGG) has started an initiative enabling Women Hospitals in Austria to join a voluntary international online CIRS. This study critically addresses the problem of preventable error leading to patient harm and investigates the contribution that CIRS, arguably one key element in the new patient safety movement, may have so that fewer patients die. This is necessary as progress in patient safety has been much slower than anticipated, despite the patient safety revival around the year 2000, increasing attention and numerous initiatives. Moreover there is little systematic documentation and contemporary knowledge about the implementation, management, and effect of CIRS in health care.This study critically investigates this gap from a critical ethnographic perspective and provides an in-depth account of CIRS in an Austrian context. The study uses interviews, a questionnaire, and fieldwork observation over a period of two years at one Women Hospital in Vienna. Interviews and questionnaire are used to assess the organisation and these data provide ground for subsequent critical ethnographic observation. The fieldwork observation in the hospital is used to illustrate ways in which this type of research can contribute to the growth of knowledge on managerial (non-clinical) aspects of patient safety. Observational studies can serve to identify latent managerial system vulnerabilities and leverage points that can aid the identification, development and implementation of overall system improvements. In addition a continuous in-depth literature review is being employed.Findings suggest that the current hospital organisation is ill resourced in implementing new patient safety strategies and effectively identifying and addressing critical incidents. In particular the study identifies latent managerial factors that complicate the performance of health care professionals and potentially contribute to adverse outcomes. It suggests that the 'systems approach' to error in health care currently focuses too much on core medical tasks and a principal separation between clinical and non clinical aspects of service provision needs to be made. Key contributions emanating from this research are a clinical / non-clinical patient safety continuum model, a patient safety framework, three phases of CIRS operationalisation, the research method employed, as well as the notion that different research ethics in different health systems require more careful interpretation of research contributions. In addition the continuous literature review reveals that one of the key arguments of the new patient safety movement, the high number of preventable errors leading to death in health care, is incorrect. This is critical as it does not allow channelling limited resources to where they are most needed. The study emphasises the need for more research in this subject area and more organisational support in health care organisations.