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BACKGROUND Patient safety, reducing medical errors and risk management have become a global public health and administrative issue. Population-based studies around the world have alerted high rates of preventable medical errors and deaths. In response, a global effort agreed on a World Health Assembly resolution on patient safety. The World Alliance for Patient Safety guideline and the Conceptual Framework for the International Classification for Patient Safety have been launched by the World Health Organization (WHO) to galvanize and facilitate efforts by all Member States to make health care safer. The guidelines introduced adverse event reporting and focus on reporting and learning to improve the safety of patient care. The WHO suggested a conceptual framework for patient safety providing comprehensive understanding of the domains of patient safety. It represents a continuous learning and improvement cycle emphasizing on proactive (identification of risk, prevention, detection, reduction of risk) and reactive (incident recovery, system resilience) risk management. The ultimate measure of a successful incident reporting system is whether the information it yields is used appropriately to improve patient and organization safety. OBJECTIVES To systematic review literature to determine incident reporting systems improve patient outcomes and organization outcomes, and to identify successful characteristics of incident reporting system which information it yields is used appropriately to improve patient and organization safety, and to investigate if the incident reporting system can serve as an interface to support the (inform and influence) information flows in the WHO’s Conceptual Framework for the International Classification for Patient Safety. METHODS Two bibliography databases, Medline and Embase via OvidSP, were systematically searched using search keywords of ‘incident reporting’, ‘patient / organization outcomes’. Quality appraisal, data extraction were conducted on literature which met the inclusion criteria. Narrative synthesis was conducted. RESULTS A total of 584 citations were initially identified and 6 studies were finally included in this systematic review. The methodological quality of the 6 included studies was generally average to poor. The 6 included studies could be classified into 3 groups by research question and intervention strategies examined 1) case series on incident reporting system; 2) comparison study on two main streams of incident reporting systems: routine incident reporting system versus structured case note / chart review; and 3) review of incident reporting systems. Successful characteristics of incident reporting system identified including confidential, non-punitive, expert analysis, system-oriented, responsive, standardized taxonomy coding, clarified and unified concepts of incident reporting system, voluntary reporting, facilitation reporting, proper training and health informatics infrastructure support. Quantitative and qualitative evidences were identified that incident reporting system could serve as an interface to support inform and influence types of information flows in the WHO’s Conceptual Framework for the ICPS. However, no evidence could be found that incident reporting systems could directly improve patient outcomes and organization outcomes. CONCLUSION This systematic review found no evidence that incident reporting systems could directly improve patient outcomes and organization outcomes, but the systems could serve as an interface to support information flows in the WHO’s Conceptual Framework for the ICPS. Successful characteristics of an incident reporting system were identified coherent to the WHO’s recommendations. Future studies can further examine the causation relationship between incident reporting systems and the process components by applying the Donabedian’s structure-process-outcome model. / published_or_final_version / Public Health / Master / Master of Public Health

M.Cur. / The study on the quality of nursing unit management was done in the four training hospitals approved for registered nurses' training in Namibia. There are no written standards on the quality of unit management in the hospitals. The objectives of the study were to formulate standards on quality nursing unit management and to evaluate compliance of clinical units with these standards A quantitative, contextual, descriptive and evaluative research design was followed. The study was done in two phases. In phase one, standards were formulated by means of a literature study by the researcher and validated through consensus discussion groups with nurse managers representing the different management levels and clinical disciplines. Purposive sampling was used and 25 participants rated the draft standards for relevance, representativeness, completeness and clarity. A rating instrument for this purpose was attached to the draft standards in the form of a questionnaire, and posted to participants, before the consensus discussion groups. Reliability and validity of the instrument and related items were ensured through the development of a conceptual framework and the consensus discussion groups. The pilot study indicated that a rating scale of 'Compliance', Partial Compliance, 'Non-Compliance' and 'Not Applicable' are more appropriated. Phase two represents the quality survey for the compliance with standards. The sample for the quality survey included 60 units from all four hospitals, representative of all clinical disciplines. Data was collected by means of interviews, observation and document analysis, using an evaluation instrument. Two surveyors, the researcher and a colleague, both lecturers from the Department of Nursing, University of Namibia, were involved in the data collection process. Double evaluations were done in 19 clinical units, representing 31,7% of the total clinical units (n=60), and the researcher alone evaluated 41 units, representing 68,3%. A high inter-rater reliability between the ratings of the surveyors was proven. The ethical principles of informed consent and anonymity have been adhered to throughout the study. Data was analysed through statistical analysis and are presented as descriptive statistics and comparative statistics. The findings revealed that, although unit nurse managers emphasise unit organisation, the quality of nursing unit management in the training hospitals in Namibia is poor. The findings also revealed that a need exists to empower nurse managers through in-service education on strategic planning as well as quality management in general. The recommendations from this study are to make written standards available, to empower nurse managers in quality management, to validate standards for quality nursing unit management nationally in the Namibian hospitals and for further research.

Risk management strategy is a broad discipline aimed at identifying, evaluating and handling risks by both physical and financial means. The medical aid industry in South Africa has experienced a disproportionate increase in expenditure relative to the overall economic growth. These cost pressures have placed restraints on their ability to obtain new members, which is vital when subsidizing higher risks with younger healthier members, and has resulted in losses for many schemes. Compounding the problem has been political and regulatory health care reforms as well as technological advances, which have initiated a complete restructure of the industry. This dissertation reviews the risk management strategies implemented by medical insurers in South Africa. An analysis of alternate risk management strategies is taken with the view of recommending a tentative means of making medical aids more efficient in an increasingly difficult market. / Business Management / M. Comm. (Business Management)

Risk management strategy is a broad discipline aimed at identifying, evaluating and handling risks by both physical and financial means. The medical aid industry in South Africa has experienced a disproportionate increase in expenditure relative to the overall economic growth. These cost pressures have placed restraints on their ability to obtain new members, which is vital when subsidizing higher risks with younger healthier members, and has resulted in losses for many schemes. Compounding the problem has been political and regulatory health care reforms as well as technological advances, which have initiated a complete restructure of the industry. This dissertation reviews the risk management strategies implemented by medical insurers in South Africa. An analysis of alternate risk management strategies is taken with the view of recommending a tentative means of making medical aids more efficient in an increasingly difficult market. / Business Management / M. Comm. (Business Management)

Introduction: Despite being one of the most preventable diseases, TB still remains a serious and largely neglected disease. Nurses as compared to the general population are at greater risk of acquiring nosocomial TB. This study was conducted to describe the perceptions of nurses on the underlying contributory factors that may lead to the spread of TB in the clinics treating TB patients. Methods: Quantitative, non – experimental, descriptive, exploratory and cross sectional design was used. A structured and pretested questionnaire was used. Findings: The key contributory factors identified were insufficient TB training for staff and lack of knowledge on the TB legislative framework and TB policy directives. Conclusion: The findings indicate the need for a comprehensive TB infection prevention and control policy, with associated standards for provision and practice. / Health Studies / M.A. (Public Health)

Introduction: Despite being one of the most preventable diseases, TB still remains a serious and largely neglected disease. Nurses as compared to the general population are at greater risk of acquiring nosocomial TB. This study was conducted to describe the perceptions of nurses on the underlying contributory factors that may lead to the spread of TB in the clinics treating TB patients. Methods: Quantitative, non – experimental, descriptive, exploratory and cross sectional design was used. A structured and pretested questionnaire was used. Findings: The key contributory factors identified were insufficient TB training for staff and lack of knowledge on the TB legislative framework and TB policy directives. Conclusion: The findings indicate the need for a comprehensive TB infection prevention and control policy, with associated standards for provision and practice. / Health Studies / M.A. (Public Health)