Basics of qualitative research: Grounded theory procedures and techniques

According to W. Edwards Deming, American companies require nothing less than a transformation of management style and of governmental relations with industry. In Out of the Crisis, originally published in 1982, Deming offers a theory of management based on his famous 14 Points for Management. Management's failure to plan for the future, he claims, brings about loss of market, which brings about loss of jobs. Management must be judged not only by the quarterly dividend, but by innovative plans to stay in business, protect investment, ensure future dividends, and provide more jobs through improved product and service. In simple, direct language, he explains the principles of management transformation and how to apply them.

Out of the Crisis

Lincoln, Yvonna, and Egon Guba, "Postpositivism and the Naturalist Paradigm," pp. 14-46 in Yvonna Lincoln and Egon Guba, Naturalistic Inquiry . Beverly Hills, CA: Sage, 1985.*

Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

In 1974 an article appeared in Science magazine with the dry-sounding title “Judgment Under Uncertainty: Heuristics and Biases” by a pair of psychologists who were not well known outside their discipline of decision theory. In it Amos Tversky and Daniel Kahneman introduced the world to Prospect Theory, which mapped out how humans actually behave when faced with decisions about gains and losses, in contrast to how economists assumed that people behave. Prospect Theory turned Economics on its head by demonstrating through a series of ingenious experiments that people are much more concerned with losses than they are with gains, and that framing a choice from one perspective or the other will result in decisions that are exactly the opposite of each other, even if the outcomes are monetarily the same. Prospect Theory led cognitive psychology in a new direction that began to uncover other human biases in thinking that are probably not learned but are part of our brain’s wiring.

Thinking fast and slow.

Objectives: To examine the feasibility of detecting adverse events through record review in British hospitals and to make preliminary estimates of the incidence and costs of adverse events. Design: Retrospective review of 1014 medical and nursing records. Setting: Two acute hospitals in Greater London area. Main outcome measure: Number of adverse events. Results: 110 (10.8%) patients experienced an adverse event, with an overall rate of adverse events of 11.7% when multiple adverse events were included. About half of these events were judged preventable with ordinary standards of care. A third of adverse events led to moderate or greater disability or death. Conclusions: These results suggest that adverse events are a serious source of harm to patients and a large drain on NHS resources. Some are major events; others are frequent, minor events that go unnoticed in routine clinical care but together have massive economic consequences

https://www.bmj.com/content/bmj/322/7285/517.full.pdf

Adverse events in british hospitals: preliminary retrospective record review

Adverse events are incidents in which a patient is unintentionally harmed by medical treatment. Awareness while under anaesthetic, deaths during surgery, and missed cases of meningitis are tragic for both patients and staff, and may lead to complaints or litigation. Investigations usually focus on the actions of individual doctors and seldom examine the background to these events.

In a recent case of a patient whose bowel was perforated during surgery, examination of the medical records led to criticism of the surgeon. Only later did it emerge that the operation had been carried out in near darkness because of several equipment and power problems. Adverse events usually originate in a variety of systemic features operating at different levels—the task, the team, the work environment, and the organisation. We present a framework that aims to encompass the many factors influencing clinical practice. It can be used to guide the investigation of incidents, to generate ways of assessing risk, and to focus research on the causes and prevention of adverse outcomes.



The original model for accident assessment was developed for use in complex industrial settings such as offshore drilling platforms



#### Summary points

Adverse events in which patients are harmed by medical treatment are common

Investigations which consider only actions or omissions of individual clinicians are incomplete and misleading

Psychological research shows that liability to error is strongly affected by adverse conditions of work

These conditions include high workload, inadequate supervision, poor communication, rapid change within an organisation

A framework of risk factors allows a systematic approach to safety and error reduction

In spite of increased attention to quality, errors and adverse outcomes are still frequent in clinical practice.1 The risk of iatrogenic injury to patients in acute hospitals remains high, with studies reporting rates of 4-17%.2-4 A recent American observational study found that …

Framework for analysing risk and safety in clinical medicine

Causes of prescribing errors in hospital inpatients: a prospective study

Why do people sue doctors? A study of patients and relatives taking legal action.

This article describes a method of investigating and learning from adverse events. Careful investigation and systems analysis can identify the factors that set the stage for a medical error. The author argues that the process of understanding adverse events leads to improvements in care and reductions in errors and that insensitive and inadequate handling of an incident can result in additional harm to patients and families. He outlines practical strategies to minimize the trauma resulting from adverse events.

Charles Vincent

Papers

Adverse events in british hospitals: preliminary retrospective record review

Framework for analysing risk and safety in clinical medicine

Causes of prescribing errors in hospital inpatients: a prospective study

Why do people sue doctors? A study of patients and relatives taking legal action.

Understanding and responding to adverse events.