Part I: Implementation of internal Integration of MaPSaf in

regards to Patient Safety

Concepts of Internal Integration

Common Language Group boundaries for inclusion or

exclusion Distributing power and status Developing norms of intimacy,

friendship, and love rewards and punishments explaining the unexplainable:

idealogy and religion

Levels of Patient Safety Culture

A- Pathological Waste of time to focus on patient safety issues

B- Reactive Patient safety is a serious issue and action is

only taken when an incident occurs C- Bureaucratic

Systems in place to manage patient safety D- Proactive

Alert and attentive about patient safety issues that may occur

E- Generative Patient safety is an integrated in every action

taken the organization

Private Type A Hospital

An institution that provides medical, surgical, or psychiatric care and treatment for the sick or the injured.

A B C D E

01. Common Language

The hospital obtains a systematic way of communicating. Contains many polices and procedure that staff and patients must go through. There are many records kept. They may have all these forms and policies but they are not always effectively utilized; in regards of patient information and staff. Also, the amount of information kept can be overbearing and come to little use. However, there is a formal communication met between together agencies and the hospitals and within the staff and management. Again, with the records and information gathered regarding the patient and other issues it is never audited or checked to see how effective the method is

Org. only communicates after a tragic incident.

Org. has a systematic approach communication.

Org. Has a system approach towards communication , and fully reviewed

Org. has established equality if communication on staff and patient safety issues.

02. Group Criteria

Org. only contains minimum crtieria needed

03. Dist. Power and

Status

04. Dev. Rules

05. Reward and

punishment

06. Explaining

the unexplaine

d

A

1. Common Language Although the Hospital may share a common language , in a Pathological environment conflict usually occurs when there are there are groups of people that work in the same environment assume about the other without any communication. Therefore in a type A hospital the Communication is very poor. The communication travels from the top down. Staff are unable or do not care to question the managers and upper authority in this case the Nurse assistants, nurses, Physician Assistants listen to the doctors regarding the risk of a patient and or other issues in the hospital. There is no concern or need to question the upper influence. Usually communication is very negative and more interested fault and blame. In regards to the patients, there is very little concern in informing the patients anything only communicate and provides the information that much be given due to legal reasons. The information is only given out of pressure of the organization.

B

Common Lang. The Hospital may share a common language. But the communication between staff and management is very limited. It also works similar to a top down type communication. This may only alter during a tragic incident . During such incidents the communication is very impromptu and rather than communicating with all units in the hospital to prevent such incidents it kept within those that are involved in the situation. In regards to the patients the information given is that only of what the hospital thinks is necessarily.

C

Common Lang. The hospital obtains a systematic way of communicating. Contains many polices and procedure that staff and patients must go through. There are many records kept. They may have all these forms and policies but they are not always effectively utilized; in regards of patient information and staff. Also, the amount of information kept can be overbearing and come to little use. However, there is a formal communication met between together agencies and the hospitals and within the staff and management. Again, with the records and information gathered regarding the patient and other issues it is never audited or checked to see how effective the method is.

Common Language and D- Proactive

The hospital contains a system of and records that are co fully audited. There is communication amongst the orgnzaization. All staff are involved. There are many forms to communicate and give feed back regarding the hostipal. Information regarding the patient and staff saftey is shared and audited. The staff of the hospital communicate with the patietns regarding saftey issues and public involvment groups.

Common Language and E – Generative

The communication between the staff and the pateitns regarding safety is equal. The management and leaders of the hospital understand that open communication is nesscary and much can be learned from the staff that they manage. Everyone is expeected to known about and learn each others experiences that took palce in the hosptial to prevent hazardous incidents nad or learn more precautious saftey measures. Patients are key in risk management and they are well informmed and involved. New ideas are always encoraged. Criticism is accepted as well. Electronic communcation is established.

Developing Rules and A –Pathological

The hospital follows only the bare minimum guidelines (mostly due to Government regulation) this would entail polices, auditing, recording, rules, regulations, committees and strategies to prevent hazardous incidents. Safety management, does not interest this level of organization. If something were to occur it would be outside of the staff’s control and claimed to be bad luck. Even after an incident occurs the Management and staff do not care to improve or discuss changes (since communication is lacking). There is no concern for the safety of the patient and if an incident were to take place the risks are worth taking because the problems can use insurance schemes to bail them out.

Developing Rules and B- Reactive

This type of Hospital contains rules and regulations regarding safety issues but the policies, rules committees etcetera are only primarily used after an incident has occurred. There is no strategy regarding risk management only until after something takes place and once the incident ahs passed then the hospital forgets about maintaining safety precautions to prevent similar incidents. This type of hospital is concerned with protecting their image and the organization and less concerned of the welfare and safety of the patients.

Group Criteria and C – Bureaucratic

This type of hospital contains many systems and rules, regulations and records that must be followed,with lots and lots of paperwork; in regards to saftey management. That must be completed by staff and pateitns. Therefore, patietn and staff safety is acknowldeged and important. However, the overload of all the rules and paperwork become merely formal tasks needed to be taken and rear away from the importance of what the paperwork and rules actually represent; safety to the staff and pateitns. Therefore, all these polices and procedure are audited but not strategical. Therefore in an incident were to occur because of the complex system a quick respone would be impossilbe.

Developing Rules and D – Proactive Safety is of utmost importance in this type of

hosptital. It contains inclusion and exclusion critera that are followed by the staff and managmetn of the hopital. They have ste of rules, and reuguatlsona nd contasnt audits to make sure that the to make imorvemtsna nd increae the quality of the safety in the hostpaial. The polices and regualtiosn establlismed are constantly reviewdevleopmend and revirewed by the staff. Contain committes with regular meetings to improve the safety conditions. Patients are also invovled in making imporovements regarding the polices and reguaktions in the hospital to make it safe as psossilbe.

Devleoping Rules and E – Generative

This type of hospital has integrated patient safety and staff safety in all levels o the hospital. They are committees, teams, services organized to audit their programs and it is always patient care focused. The staff working are alert and know all the polices and protocols needed to be taken at time of incident. The patients come first in every aspect therefore their feedback is very important and valued in the hospital by the staff and management. This allows the hospitals to further improve and manage safety and constantly discuss improvements. Safety is always their main concern.

Power and Status and Type A - Pathological

This hospital has extreme lack of distribution of power and status. Those who managmetn and are head authroity of the hospital have the most power and say in every aspect of the organzation. They run the rule and regualtions. The staff only work at the hospitl they have no internest nor any power to question the authority. As for the patients they also have very little say, their opinion does not matter. The patient is of very little concern. There is no harmony amoungst the staff and the managmetn. There are many hiearchies with the organization. Many people work on their own rather than together. But it can be described as a group of people forced to work together under insignificant leader.

Power and Status and B - Reactive

There is a unequal distribution of power in this type of hosptial as well. The staff are put in ‘teams’ but not by choice only when an incident has occurred. This is only done in response to external reaction and demands. Therefore there is a hieratchy not only outside of the team (those that put the team together) but also within the team itself. Again, also of the actions taken in response to an incident to proteect the organization as a whole. The staff and the pateitns safety are of little interst.

Power and Status and C - Bureaucratic

This system also contains unequal distribution of power and status. The numeroys systems and polices are created by the higher levels managmetn which must be followed and completed by the staff. They must go through loads of procedures. The staff do not question them becaue they are protocol.

Power and status and D - Proactive

The distribution of power and status is not a priority or relevant. There is communication and between the management and the staff. There is no view of the management having more or greater status than the staff and patients. They all work as a team in order to prevent hazardous incidents and to keep the patients safe and satisfied. The team is than evaluated by others to see how effective it is.

Power and Status and E - Generative

The distribution of power and status is not a relevant. There is communication and mutual respect between the management and the staff. They all share the same vision have similar values which allows them to work great together. They also work together and are flexible. They a with different people including the patients. Everyone is equally valued. This includes everyone that contributes to the hospital including technicians, support staff etcetera. They all work as a team in order to prevent hazardous incidents and to keep the patients safe and satisfied.

Group Criteria and A - Pathological

Take limited precaution of who can and cannot work in the hosptial and be administered in the hospital. Staff are only seen as people who fill the postion just fulfill the quota. There is no HR policy, and construction of staff development. For example, they are not concerned with the quality of the staff rather just having the quantity needed to run the hosptial. Also, do not have realm of what patients can and cannot be administered in the hospital. Rather are only interserested in administering as many patients without really giving direct concern or care for the patient. Patietn is considered just a number and just more money for the organization. Again as stated previously, if an incident occurs the insuranc scheme can bail them out.

Group Criteria and B - Reactive

This type of hospital has inclusion and exclusion criteria but is not followed adamantly. Unless an accident occurs the management na will react and hire staff and etcetera that may have qualifications that fit the desirable criteria. But once the distress of the incident quiets down the administration will once again lack interest in following the criteria of the staff. The patients also lack inclusion and exclusion criteria. Since they are not concerned with the ability of the staff, the patients are also at risk. But action is only taken in regards to the patient unless an accident occurs.

Group Criteria and C - Bureaucratic

The hospital contains extensive amounts of policies and rules regarding the inclusion and exclusion criteria regarding the staff. They quality of the staff is important. However, the amounts of paperwork and guidelines that need to be followed make the process of hiring staff a long and extensive procedure. This is a similar situation for patients,before they are adminstered they must go though lots of rules and paperwork before they are adminstered. The complexity of the system is not in favor of the hosptial at all. It rather slows many things down and most of the paperwork is irrelevant.

Group Criteria and D - Proactive

This hospital is very concerned with the quality of staff and the realm of apteitns they can give care to. They have inclusion and exclusion criteria for both groups. Which, are constantly monitered and have committees such as the HR department that focus on finding the best staff to ensure a great service for the their patients. Always looking to see what criteria is effective in improiving their service. Such as a ones with great educatin backroudn and experience etcetra.They find it very important to be the best and compare themselve with their competion. As for the patients, because ehtye are focused on finding great staff to provide saftery and imporement in their patietns lives they make sure that before they adminster the patint they fit the criteria and know that the patietn will be safe and they will be able to provide the service that they need.

Group Criteria E - Proactive This hospital is always focused on the quality of

the staff and the paitents. They have inclusion and exclusion criteria that is constnatly monitered and reviewed. They observe all aspects of the staff making sure that thye are well-rounded indivuals. They are interseted of providing service that will not only improve the patietns health but also offer them an experience in which they feel comfortable and cared for. The primary focus is that the patients feels comfortable and at home. The hosptial is flexible to change in the inclusion and exclusion criteria. Qulaity is iwhat is important not quantity. They also have criteria for the patients and they make sure that they also fit the criteria of the service they can provide so that he patient can remain safe.

Reward and Punishment and type A - Pathological The staff are looked merely as objects that fill

positions and the patients are also not a priority. There is little interest or concern in reward or punishment. The environment itself is very negative. Therefore, being in such an environment is a punishment itself. There really are no rewards or punishments in this type of hospital. The worst penalty for a staff would be losing their jobs and the worst punishment for the hosptial would be closing down. There are no rewards other htan money in this type of hosptial. As for the patients there is lack concern for the safety, the best reward is leaving the hospital safe and healthy.

Reward and Punishment and type B - Reactive

The hospital is interested in rewards only especially protecting the organization. Therefore, they are only reactive when an incident occurs. Those involved in the incident have suffered. But the hospital takes action after the incident and create rules and punishes individuals that may have caused or been involved . After the incident eh prgranization is punished for their lack of precaution.

Reward and Punishment and type C - Bureaucratic

This hospital contains many levels and procedures regarding safety management. But because the processes are so time consuming and long the if the staff do not follow the strict procedures the management must take action to punish the staff. Therefore, they may force a staff on leave if they are not doing certain rules and regualtions. Also, if these procedures are not followd an an inccident occurs. An outside system will punish the hosptial for its mistakes. As, for rewards as time goes on the level of senority is important in a buracratic system. Rewards, may go for increasing pay, or status of seniority. All for being a staff that follows the rules and stays in the hospital for long and managing risk safety. As for patients they are concerned with safety and rewards goes for keeping the patients helathy and safe. Punishments would entail not being able to treat a pateitn decreasing their safety and health.

Reward and Punishment and D - Proactive This hospital values both the staff and

the patients. Therefore there are rewards and punishments that have been implemeted in all levels of the system. They analyze to see how effective some of the reward and punishments go on the performance of the staff and the wellbeing of the patients and overall the safety of the staff and patients. The punishments would entail in terms of safety increasing risk in the staff and patietns enviorment. Rewards would entail seeing the satsifaction and safety of the pateitns and staff.

Rewards and Punishments and A – Generative This type of hosptial is highly concerned with

every aspect of the pateint and the staff. Their safety is on great concern. This type of enviometn is very flexible and has a great communication establsihed between the patients and the staff. Therefore, there are little set reguatlsions and rules regarding rewards and punishments because the organization strives to keep the staff and patients happy with the surroundings and safe. If something were to go was an incident to occur they have a committee set with actiosnt aht need to be taken, to punish and or reward the indviual. But they are always open for changes and discussions.

Explaining the Unexplained A They have little concern over the patients

and staff. It is possible that they leave things to god rather than to work and prevent incidents from occurring. If a patient and staff are suffering it is due to their karma. Correction is based on religious practice rather than improving the organization. In terms of ideology, if it is a capitalist based organization the employees only work for the benefit of money. More focused on profit rather than people.

Explaining the unexplained type B This organization reacts based on

the belief system of their society to protect their image. For example if an accident occurs and they live in a religious society they focus on what answers would satisfy the society and protect their organization. But primarily they are concerned with profit and that the reaction is based on preserving their money.

Explaining the unexplained type C In this organization they consist of a

strict work ethic. Which is not open to change. If an incident were to occur it would blamed on an external factor not related to their work. There is still emphasis on the process of the organization at the expense of the welfare of the people.

Explaining the unexplained type D This hospital is more interested in

fining the unexplained through scientific research. They have research committees dedicated in answering the unknown. They collaborate with other organizations to further their knowledge in such concerns. There is a equal balance between employees, safety and profit.

Explaining the unexplained type E They approach profit not on the basis

on the money. The safety is the profit. They are open-minded and flexible to meet the needs of the employees and the patients. Their aim is to improve benefit of patients and staff rather than focus on money.

Part II: Implementation of external adaptation of MaPSaf

in regards to Patient Safety

Concepts of External Adaptation

Mission and strategy Goals Means Measurement Correction

Levels of Patient Safety Culture

A- Pathological Waste of time to focus on patient safety issues

B- Reactive Patient safety is a serious issue and action is

only taken when an incident occurs C- Bureaucratic

Systems in place to manage patient safety D- Proactive

Alert and attentive about patient safety issues that may occur

E- Generative Patient safety is an integrated in every action

taken the organization

A B C D E

01. Mission and

Strategy

No shared concept of mission amongst the workers in the hospital

02. Goal

03.Means

04. Measureme

nt

05. Correction

Mission type A

This hospital may contain a mission but there no concern with fulfilling the mission because the organzation itself does not share the same desires or beliefs. There is no concern for the staff, patients and for the quality of the organzation itself.

Mission type b

This organization contains a mission merely as a way to set its image. It however only becomes concerned in fulfilling the image when there is threat on the organization itself, due to an incident that may not adhere to their mission, which should include concern towards the safety of the staff and patients of the hospital.

Mission type C

The mission is very important in this type of hospital. Safety should be entailed in their mission. They create rules and polices that follow the statement. However, with the overload of procedures sometimes overall understand and goal of the organization is forgotten and lost.

Mission type d

The mission is what main aspect of what the hostial represents. They strve to fulfill the mission. The staff and patients also share and follow the mission. They contatly analayze and see how effective the different levels adhere to the mission. Safety is of huge importance in their mission fro the staff and pateitns.

Mission type E

The mission is shared by the patietns and staff. They constantly get feedback and opinions on how to imporve and create a mission that everyone shares. They are flexible and willing to work with everyone to create a friendly and risk free enviorment there are some of the main componnets in their mission.

Goal and Type A

Not interested in forming goals. Since the staff and patients are not of any true concern. They have no shared assumptions and values. Without these components they cannot form and achieve goals to improve the organization.

Goal and Type B

They have goals to achieve certain end points. But they are not go great concern or interest. It is only until a major component of their mission such as safety is affected through an incident. That they strive to achieve their goals of keeping the enviometn safe. Once the incidnet has been forgtten the orgnaization goes back to a careless routine until the next incident occurs.

Goal and type C

They have a extensive amount of goals to achieve. But within these goals they have levels of procedures that must be completed in order to achieve these goals. They again overload the staff and patient with lots of paperwork and such that in the end they lose sight of what achieving the goal.

Goal and type D

They have goals created and discussed from feedback of the staff and pateints. They want to make sure that they have the most effective and plausible goals to achieve. They compare their goals with their competion and make sure that they can just the same if not better.

Goal type E

This type of hostapital is always flexilbe and creating goals that can be achevied by the pateitsn and staff. They main concern is to fulfill goals that can be achieved. Also, the staff and patietns share teh same values and beliefs for the organization.

Means and type A

This type of organization contains minimum means. Because they do as a whole share the same mission and carry out the goals to achieve towards the mission. They only have simple structure in regards to the means to keep the organization to just function. They create minimum outlines of design of tasks, division of labor, org structure, reward and incentive system control system info systems.

Means type B

This system has also the bare minium means, such previosuly state. But they do not use these componnets until an incident occurs which causes they to react. In order to preserve their image and protect their organizatoin they follow the means.

Means type C

This system has created an elborate system of means. They have divided taks and division of labor into organized structures and created an incenttive system to control system and information system. However, these subgroups of means are very complex. This procedures slow down the perfromcance of the organization. This also creates stress and overlaod to the patietnsand staff.

Means type D

They have have a great system scheme of means. All of which have been discussed by the staff and the feedback of the paiiets. To create as safe and smooth system for the organization to work with. They constiously observe the set to see how effective it is and what kidn of improvements can be made to become more successful.

Means type E

This type of hospital has created a flexible but productive system of means. A system where everyone can work together as a team but tasks are seperated and division of labor is also seperated. The system runs smooth and is very effective. The staff and pateitns feel satisfed, comfortalbe and safe. They are always open for changes and creating a more efficient system.

Measuring Results type A

Not concerned in improving their environment. Therefore, there is no need to measure results. Since, they believe that if any accident were to occur it is only based on bad luck.

Measuring Results type B

Only intersted in measureing results and effectivness on their organization when an inciddent occurs. Prepares commitees focused on tasks and measuring results on the incident and how to stop it and maybe prevent it. After the incident occurs the organization becomes unintersted in preventing incidents. Only intersted in protecting the organization.

Measuring Results type C

In a bureacraticc system there are many audits made to make sure tat the systems are working correctly. However, it is never analysed to see how effective the system is. Htye have many records on file and lots of paper work regarding all the procideures but little of the paperwork is utlized.

Measuring results type D

In this type of organization is concerened about the outcome and safety of the emplyoees and patients. They have frequent audits from outside organizations. Also, within the hosptial they have commites dedicated to observiving the docotrs, nurses and other staff and their conserideratiom of safety issues.

Measuring Results type E

This type of hospital is consistly checking safety in all levels of the organization. They have complain bureau dedicated for patients to give feedback and criticism regarding performance of the hospital. Auditing within the organization is a weekly routine, it is integrated into the staffs organization policy. Flexible to change in terms building materials at the expense of spending money.

Corrections type A

If anything incident occurs they do not blame it on the organization they blame it on bad luck. They do not work on correction. It is more likely they prefer to be bailed out by insurance schemes.

Correction Type B

This type of organization only reacts to correct when an incident takes place. Only works on one level of the process. Or enough to protect the organizations image. It does not base the correction on safety more based on money and preserving image.

Correction type C

This type is of organization. They use punishment base rather than solving the incident. For example, firing a doctor to solve the issue rather than changing the selection process of hiring. They contain many complicated procedures that lead to no result in solving the issue.

Correction type D

They are more concerned regarding broader safety issues and do not pay attention to smaller details. They are concerned with life risking situations but not smaller dangers. They have an open communication with the staff and patients to improve ways of evaluating and resolving safety concerns.

Correction type E

This organization reviews minor to major details in safety issues. They are always prepared for the worst situation. They have resources readily prepared for correction. They staff and patients are knowledge on how to approach a safety issue. They are readily take responsible for any incident to occur rather than devoid the problem.

Works Cited

http://nzma.org.nz/journal/123-1314/4112/

Done By:

Janaki Shah-  Grand Valley State

University –UNITED STATES OF America

Shogi Almaayn-Sana'a University - Yemen

To: Middle East Technical University