A Study of the Relationship between Hospitals’ Governance / Management Structures and Patient Safety
Impact of Accreditation
Ireland
To investigate the impact that an organisation’s governance or management structure has on the organisation’s approach to patient safety. 1. To identify the governance / management structures in place in each of the first fourteen hospitals surveyed as part of the Acute Care Accreditation Scheme (ACAS) of the Irish Health Services Accreditation Board; 2. To identify if there is a relationship between the hospital approach to patient safety as exemplified in the ratings received for specified patient safety criteria and the governance / management structures that they have in place
Objective: To identify the governance / management structures in hospitals surveyed as part of the Irish Health Services Accreditation Board’s Acute Care Accreditation Scheme and to identify if these have an impact on a hospital’s approach to patient safety.
Design and setting: Data including ratings for the patient safety criteria was collected from 14 hospital accreditation reports.
1. Literature review to identify governance/management structure classifications; 2. Data collected from the first 14 hospital’s survey reports from which identification and classification of the main types of governance / management structures was made and the ratings for the patient safety criteria in all standards were collected; Data AnalysisEach organisation had four non care teams giving a total of 14 teams. The number of care/service teams per hospital varied depending on the size and range of services provided. There were a total of 110 care/service teams.
Hospitals
In terms of governance structures, surveyed hospitals could be categorised as either Health Service Executive (HSE) or voluntary hospitals. Teams based in voluntary hospitals were generally more compliant than HSE hospitals in relation to the non care/service patient safety criteria. A reverse in the trend was noted for the care/service patient safety criteria. However, only one criterion was statistically significant and it is concerned with organ and tissue donation processes. In relation to the management structures, teams based in organisations with Clinicians in Management / Clinical Directorate management structures performed slightly better than those with traditional bureaucratic management structures in relation to the non care/service criteria. Interestingly again, the opposite was the case for the care/service standard group. However, only one relationship was statistically significant and this relates to the processes for assisting teams in supporting patients when their choice is limited due to legal restrictions. Conclusion: The results highlight some interesting issues with regards to differences noted in performance between care and non care teams, but they do not conclusively demonstrate if certain governance or management structures are more conducive to patient safety than others.
With only 14 non care teams, the population was too small for statistical significance testing. The population of 110 care/service teams was sufficient for significance testing with the chi square statistic and a probability of .05 or less to determine whether or not a relationship was statistically significant
April 2006