Safe Surgery in Australian Hospitals: Implementation of the Correct Patient, Correct Site, Correct Procedure Protocol
Date
Authors
Australian National University. Regulatory Institutions Network
Healy, Judith
Journal Title
Journal ISSN
Volume Title
Publisher
The Australian National University, Regulatory Institutions Network (RegNet)
Abstract
Report to the Australian Commission for Safety and Quality in Health Care.
Background: Health policy makers in many countries have proposed protocols to reduce socalled
‘never events’, meaning adverse incidents in hospitals that are preventable, such as
incidents involving the wrong patient, wrong site, or wrong procedure. Reporting systems now
indicate that these types of adverse incidents are more frequent than initially assumed; for
example, 53 such incidents were reported across Australia for 2004-05. The Australian Health
Ministers in April 2004 called for all public hospitals in Australia to implement the ‘Ensuring
Correct Patient, Correct Site, Correct Procedure’ protocol, as part of a broad strategy to introduce
and standardize patient safety check procedures in hospitals.
Aims: This study sought lessons for health sector governance from experiences with the protocol.
Did policy implementation differ between States and between hospitals? Did different groups of
professionals support or object to the protocol? What strategies were used to promote compliance
with the protocol by hospitals and health professionals?
Methods: Information was obtained from the eight States and Territories on implementation
strategies and audits. A literature review and website search was undertaken. Over 72 interviews
were conducted with national and State policy makers, hospital managers, and health
professionals.
Results: Promulgation of the protocol differed between the States, reflecting different public
sector cultures and administrative structures, with the States variously issuing guidelines, policies
and directives. Most States left it to hospitals to work out the details of the protocol and many
hospitals left it to units and/or clinicians. Most hospitals began by introducing the protocol in
operating theatres. The take-up of a protocol within a hospital depends upon its acceptability to
health professionals, and introducing a standard procedure into operating theatres proved more
difficult than expected, especially since patient identification practices vary between surgical
specialties. The protocol also revealed different safety cultures, since nurses generally tend to
prefer rules-based practice while surgeons prefer discretionary practice. In some hospitals, rather
than an opportunity for team-building, the protocol aggravated tensions between professional
groups. Hospital managers tried multiple regulatory mechanisms, both supports and sanctions, to
promote compliance. Most began with softer mechanisms, such as information and training, and
later escalated to stronger mechanisms, but stopped short of severe sanctions. Some hospital
audits suggest that protocol compliance in operating theatres in general rose over four years from
below 30 percent to over 70 percent and in some units rose to over 90 percent.
Conclusions: Policy makers saw the protocol as a self-evidently sensible solution. Compliance by
health professionals, however, proved to be low and slow, especially since the authority attached
to the protocol was often ambiguous. Hospital managers proved to be responsive regulators in that
they tried multiple regulatory mechanisms. Achieving compliance required supplementing the soft
mechanisms traditionally used by the health sector by stronger mechanisms, however, such as
directives issued by clinical leaders, and by regular compliance monitoring. Once embedded in
operating theatres as ‘the way we do things’, the protocol appears to be low-cost and not intrusive
in terms of staff time and effort. Although the principle of a patient safety check generally is
accepted, there was little agreement on the principle of a standard protocol, either within many
hospitals or within a State, let alone across Australia.
Description
Keywords
Citation
Source
Type
Working/Technical Paper
Report (Commissioned)
Report (Commissioned)
Book Title
Entity type
Access Statement
Open Access
License Rights
This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.