Organisational and systems factors impacting on patient safety in acute care organisations: lessons from four multi-site research studies

Background Patient safety is concerned with preventable harm in healthcare, a subject that became a focus for study in the UK in the late 1990s. How to improve patient safety, presented both a practical and a research challenge in the early 2000s, leading to the eleven publications presented in this thesis. Research question The overarching research question was: What are the key organisational and systems factors that impact on patient safety, and how can these best be researched? Methods Research was conducted in over 40 acute care organisations in the UK and Europe between 2006 and 2013. The approaches included surveys, interviews, documentary analysis and non-participant observation. Two studies were longitudinal. Results The findings reveal the nature and extent of poor systems reliability and its effect on patient safety; the factors underpinning cases of patient harm; the cultural issues impacting on safety and quality; and the importance of a common language for quality and safety across an organisation. Across the publications, nine key organisational and systems factors emerged as important for patient safety improvement. These include leadership stability; data infrastructure; measurement capability; standardisation of clinical systems; and creating an open and fair collective culture where poor safety is challenged. Conclusions and contribution to knowledge The research presented in the publications has provided a more complete understanding of the organisation and systems factors underpinning safer healthcare. Lessons are drawn to inform methods for future research, including: how to define success in patient safety improvement studies; how to take into account external influences during longitudinal studies; and how to confirm meaning in multi-language research. Finally, recommendations for future research include assessing the support required to maintain a patient safety focus during periods of major change or austerity; the skills needed by healthcare leaders; and the implications of poor data infrastructure.

Special Section Guest Editorial: Image/Video Quality and System Performance

Rapid developments in display technologies, digital printing, imaging sensors, image processing and image transmission are providing new possibilities for creating and conveying visual content. In an age in which images and video are ubiquitous and where mobile, satellite, and three-dimensional (3-D) imaging have become ordinary experiences, quantification of the performance of modern imaging systems requires appropriate approaches. At the end of the imaging chain, a human observer must decide whether images and video are of a satisfactory visual quality. Hence the measurement and modeling of perceived image quality is of crucial importance, not only in visual arts and commercial applications but also in scientific and entertainment environments. Advances in our understanding of the human visual system offer new possibilities for creating visually superior imaging systems and promise more accurate modeling of image quality. As a result, there is a profusion of new research on imaging performance and perceived quality.