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.

Kahvehane Kongresspark

“Kahvehane (Coffeehouse) Kongresspark”explores the question of transcultural relations and belonging through an artistic exploration of coffee and its cultural history. The project was commissioned as an urban art intervention by the 'Soho in Ottakring' Biennial in Vienna. Organic and fair-trade coffee, sponsored by Kaffee Alt Wien , was served free of charge to the public in specially designed cups and saucers, which were created at the Ceramics Research Centre at the University of Westminster. The designs reflect coffee’s shared multi-ethnic history and the globalization of coffee.The project includes an interactive lecture-performance exploring the many legends about the origins of coffee tracing its journey from Ethiopia, the Arabian peninsula through the Ottoman Empire (Turkey) to Vienna and across the entire globe. While adopting a humorous take on the globalization of coffee, the performance sheds light on the history of colonialism and question the conditions of contemporary trade. The performance was written and performed in collaboration with Bharatanatyam artist and actor Shane Shambhu.