Background
Methods
Design
Recruitment
Data collection and interview guide
Data analysis
Results
N = 72 | |
---|---|
Sex | |
Female | 35 (48.6%) |
Male | 37 (51.4%) |
Type of practice | |
Solo practice | 33 (45.8%) |
Joint practice | 28 (38.9%) |
Medical service center | 6 (8.3%) |
Group practice | 5 (6.9%) |
Specialty | |
General practice | 15 (20.8%) |
Dermatology | 15 (20.8%) |
Orthopedic surgery | 15 (20.8%) |
Psychiatry/Psychotherapy | 10 (13.9%) |
Dentistry | 17 (23.6%) |
Number of non-physician employees in practice (n = 70) | |
Mean (SD) | 6.2 (4.5) (Min. 0; Max. 29) |
Number of physicians in practice | |
Mean (SD) | 2.3 (1.6) (Min. 1; Max. 8) |
Professional experience as physician (in years) (n = 71) | |
Mean (SD) | 24.9 (10.3) (Min. 3; Max. 44) |
Years working in current practice | |
Mean (SD) | 12.9 (9.2) (Min. 1; Max. 32) |
Function in practice | |
Practice owner | 58 (80.6%) |
Physician employee | 14 (19.4%) |
Understanding of the term “critical incident”
Discussion of events
»And that’s where such things – problems and mistakes - are discussed and that’s where we, as a team, try to find solutions and ways of preventing them« (A11)
»And the following Wednesday, we discuss the topic again, and we ask the whole group: “Did things work out ok?” “What do the others think?” “Who noticed anything different?” “And where did things not go smoothly?”.« (D82)
»And then we all meet up in the kitchen […] that’s how we do it, we get together more or less straightaway, and then discuss it. We communicate quickly, basically immediately.« (A47)
»Then we discuss it afterwards. […] Ours is just a small practice. One or two health care assistants are there at most. So you generally find out about everything directly and can say, “no, please do it like this”, or “correct it by doing that”, or “call up again and rectify the situation”.« (A02)
»In the case of one patient, who was taking hydromorphone, the wrong dose was written down. So she of course received twice the dose she should have. But that wasn’t noticed until she came back wanting a follow-up prescription, after having been to hospital in the meantime. Whether that had anything to do with the medication was difficult to ascertain. But of course we changed the follow-up prescription.« (O42)
»Yes, in our case, if we pull out the wrong tooth, for example, then it’s no problem, we just provide a dental implant free of charge. When we see it’s our mistake, then we try to correct it and to be fair about it.« (Z21)
»Sometimes we can correct things that have gone wrong immediately. Then it’s all over, after the correction has been made.« (A02)
Documentation of events
Types of preventive measures
System-oriented measures
»Well, let’s say an erroneous prescription is issued – how can that be? Where in the process can there be a problem that makes that kind of mistake crop up? So we discuss the processes, and when you notice – Aha! It’s because of a certain click on the PC […] then that particular thing will be specified in the workflow accordingly.« (C70)
»So when our Wednesday meeting begins with, perhaps, someone saying: "This and that didn’t go very well" And then someone else says: "Yes, who was it this time?" Then we immediately interrupt and say, "it makes no difference who it was. No one needs to know who it was. Let’s just ask ourselves why it happened and why we don’t want it to happen again."« (D82)
Person-oriented measures
»And if they do occur, then the person responsible for it, even if it’s me, is severely reprimanded. I would say: "Now listen, you know we can‘t let that happen." And then at our regular official meeting, it‘s simply mentioned again: "It’s ok, it happens, pay more attention next time".« (Z29)
»When I notice that the quality of my work is declining, and I think it’s important that I am always my own harshest critic. That’s why I’m always taking part in further education and training programs. I learn the most from them and I accept new solutions and integrate them into my work.« (Z63)
Participants’ safety culture
»Well everyone’s afraid of making mistakes, aren’t they? And you have to try to take that fear away from people, right? Because everyone makes mistakes, you can’t completely prevent them, and you have to learn to deal with them.« (C068)
»And being honest with the patients. That is the most difficult thing but also the most important thing. Most patients appreciate it.« (Z079)
»And no one discussed how it happened, and they just said, “no, that shouldn’t happen”. And they listened to what happened and had a positive attitude towards the whole thing, but in the implementation, there was always a reason why the implementation couldn’t be successful.« (A34)
»And, well, I have worked in three practices and three, four or five clinics and, to be honest, I have rarely experienced anything else. That is to say in most clinics and practices, it was always the case that the first question was: “Who was it?”.« (D82)
»In medical training, the only thing you learn about is medicine, nothing else.« (D82)