Hospital care is said to be 3000 times more dangerous than air travel, with medical errors killing thousands of patients every year. Such incidents reflect only the tip of the iceberg; equal prominence should be given to near misses, events that could have inflicted patient harm. The analysis of near misses helps preempt injury by revealing deep-rooted system causal factors and by offering recovery strategies. Unfortunately, near misses are overlooked as sources of learning in favor of harmful events. Moreover, the literature explaining how hospitals can benefit from near misses is scarce.
This exploratory qualitative research examined concrete processes associated with learning from near misses in the setting of Abu Dhabi hospitals. The ‘Learning from Near Misses Maturity Model’, an innovative framework, was developed based on current safety and organizational theory literature. The model’s value proposition lays in its dual-purpose and practical approach. Hospitals can use it to evaluate their readiness for and progress towards successful learning from near misses. They can also adopt it as a roadmap to improve this process for patient safety. The preliminary model included ten critical success factors (CSFs) addressing key aspects of near misses - organizational policy, staff awareness, reporting mechanisms, dissemination and institutionalization of lessons learned just to name a few. This model was reviewed by fifty-eight local and international experts using online questionnaires, which resulted in a refined version of eight consolidated CSFs. It was then validated in the laboratory and pharmacy departments of four hospitals, using a combination of focus group interviews and participatory action research projects.
The findings reveal that the model guides hospitals to improve their process of learning from near misses. This is noteworthy as the literature indicates that effective organizational learning from such incidents leads to system enhancements and reductions in occurrence of harmful events. The study also demonstrated that improvements occurred through the concomitant implementation of all eight CSFs of the model. Furthermore, it showed that several pre-existing structures must be in place to support its implementation: an engaged leadership, a conducive culture and cross-departmental collaboration within the hospital.
As there are currently no comparable frameworks published, this actionable model will be valuable for healthcare professionals as they are increasingly required to improve patient safety proactively. Future studies in different hospital departments and healthcare settings will be instrumental to identify potential variations of the proposed CSFs for organizational learning from near misses.
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