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Healthcare Professional Experiences of Clinical Incident in Hong Kong: a Qualitative Study

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Healthcare Professional Experiences of Clinical Incident in Hong Kong: a Qualitative Study Risk Management and Healthcare Policy Dovepress open access to scientific and medical research Open Access Full Text Article ORIGINAL RESEARCH Healthcare Professional Experiences of Clinical Incident in Hong Kong: A Qualitative Study This article was published in the following Dove Press journal: Risk Management and Healthcare Policy Leung Andrew Luk1 Background: Studies showed that adverse events within health care settings can lead to two Fung Kam Iris Lee 1 victims. The first victim is the patient and family and the second victim is the involved Chi Shan Lam2 healthcare professionals. However, there is a lack of research studying the experiences of Hing Yu So 3 healthcare professionals encountering clinical incidents in Hong Kong. This paper reports Yuk Yi Michelle Wong3 a qualitative study in exploring the healthcare professional experiences of clinical incident, their impacts and needs. Wai Sze Wacy Lui4 Methods: This study is the second part of the mixed research method with two studies 1Nethersole Institute of Continuing conducted in a cluster of hospitals in Hong Kong. Study 1 was a quantitative questionnaire Holistic Health Education (NICHE), Alice Ho Miu Ling Nethersole Charity survey and Study 2 was a qualitative In-Depth Interview. In study 2, a semi-interview guide Foundation, Hong Kong; 2Department of was used. Anesthesiology & Operating Services, Results: Results showed that symptoms experienced after the clinical incident were mostly AHNH &NDH, Hong Kong; 3Quality & Safety, New Territories East Cluster from psychological, physical, then social and lastly spiritual aspects which were consistent (Q&S, NTEC), Hong Kong; 4Oasis with those found in study 1 and other studies. Using content analysis for analyzing the Center for Personal Growth & Crisis impacts, four themes were identified. Concerning the impacts immediately from the clinical Intervention, Corporate Clinical Intervention, Corporate Clinical incident, two themes emerged were 1) facing emotion distress and 2) maintaining rationality. Psychological Services, Hospital Regarding the impacts after the clinical incident, another two themes were 3) managing Authority, Hong Kong further emotional distress 4) restoring personal wellness. With regard to the needs after clinical incidents, three themes emerged were 1) self-recovery; 2) senior good mentoring and 3) positive organization climate with emphasis on enhancement of training and devel­ Video abstract opment of a positive practice culture. Conclusion: Great impacts are found with healthcare professionals encountering clinical incidents from a holistic perspective. They need time for self-recovery with support from good supervisors, peers and a caring environment. Some recommendations based on the findings of the study are made. Keywords: clinical incident, second victim, healthcare professionals, qualitative study Background Patient safety and high quality of care are fundamental to a patient-centered holistic Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: care, which is also a demonstration of the excellence of a healthcare organization. https://youtu.be/Y6ndyTXQp_4 Patient safety has long been a major concern of healthcare professionals working in hospital settings. However, studies show that there are complications of medical care or adverse events happen because of human or system errors during patients’ hospitalization. In a landmark report by the Institute of Medicine in 1999, it was estimated that about 44,000 to 98,000 deaths occur each year in the United States as a result of medical errors.1 Based on these estimates, medical errors are ranked as Correspondence: Leung Andrew Luk 2 Email [email protected] the eighth leading cause of death in the United States. Health authorities of submit your manuscript | www.dovepress.com Risk Management and Healthcare Policy 2021:14 947–957 947 DovePress © 2021 Luk et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php http://doi.org/10.2147/RMHP.S292875 and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Luk et al Dovepress advanced countries such as the United States and the public hospitals where patient beds are usually fully occupied United Kingdom spell out the importance of learning and workload is high, particularly if they are unprepared to from any errors, either caused by people or the healthcare face crisis at work. In a cross-sectional survey of 226 valid system so as to minimize errors and create hospitals to be questionnaires from 1000 public doctors using the Maslach safer places for patients.3 With better understanding of Burnout Inventory in Hong Kong, 31.4% of the respondents errors and their contributing factors, it is hoped that the suffered from high burnout. Young but moderately experi­ knowledge of healthcare professionals in the prevention of enced doctors who need to work shifts appeared most incidents can be increased. Furthermore, if errors are vulnerable.9 A web-based cross-sectional survey on 850 found in the hospital system, it can be redesigned to fill nurses showed that nurses were more depressed, anxious up the loopholes. Reporting system has been established and stressed than the local general population. Stress was by hospital management to gather information about med­ significantly associated with younger age, clinical inexperi­ ical errors so that mistakes can be learnt. In Hong Kong, ence, past year disturbance with colleagues, low physical the Advance Incident Reporting System (AIRS) has been activity, no leisure and drinking alcohol.10 If doctors and set up by the Hospital Authority in 2004 to encourage nurses are under great stress and prone to burnout, it may hospital staff to report whenever incidents occur. Data lead to human errors. are collected for analyzing obvious causes so that preven­ Overseas studies showed that adverse events within tive measures can be taken to improve patient safety and health care settings can lead to two victims. The first victim quality of care. Besides, learning from errors, hospital staff is the patient and family and the second victim is the involved are better trained to prevent and prepare for medical health care professional.11 The term second victim was intro­ incidents. duced by Wu in 2000, and a specific definitionwas posed by However, improvements in hospital safety are still too Scott et al in 2009.12 The prevalence rates of second victims slow in United States (US) as suggested by healthcare in a review study13 varied from 10.4% up to 43.3%. A survey researchers. An overseas study in 2013 showed that an in the UK with 1463 doctors (83.3%) reported having per­ estimate of deaths, which may be due to preventable sonally been involved in at least one near miss and/or adverse medical errors was up to 400,000 per year.4 That would event at any point in their career. Of these, 1119 (76.5%) make medical errors the third leading cause of death in believed that their experience had affected their personal or America, which is behind the first, heart disease and professional lives.11 Health care institutions and clinical lea­ the second, cancer.5 In Hong Kong, there is a lack of ders are called to take accountability and provide staff with research on this area. Statistics from Hospital Authority formal and informal systems of support.14,15 However, there in recent few years showed that there is a gradual reduc­ is no local research studying the impact of clinical incident tion in the medical incidents. However, by on individual healthcare professionals. Clinical incident is September 2015, the number of reports submitted through defined by the research team of all errors involving near Advance Incident Report System (AIRS) was over misses, preventable and negligent adverse events, and all 117,000 since its establishment in 2004.6 adverse events including unanticipated non-preventable Beyond patient safety issue in hospital, health care indus­ adverse events, but excluding anticipated non-preventable try is also one of the high-risk entities worldwide because of adverse events (ie side effect, complication or consequence its high volume of users, complexity of procedures and of nature disease or treatment), and incidents that involve involvement of many stakeholders. Overseas studies showed criminal act, deliberately unsafe act, substance abuse or that healthcare professionals are under great stress and prone deliberate patient harm or abuse. to burnout though they are providing incredibly meaningful There are two research questions in this study. They and personally fulfilling job. Burnout is more commonly are: 1) what are the impacts on individual healthcare among physicians than other US workers. Physicians at professional encountering a clinical incident? 2) what are frontline of care seem to be at the greatest risk.7 Nurses their needs after the incident? The research may lead to occupying a major workforce in hospital, one study showed a better understanding of the impact of clinical incident
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