Course: Quality and Safety GW4007MV
Date: 6-11-2020
Word count: 1228 including in-text references
Introduction
Healthcare organizations in the Netherlands are obliged to extensively investigate the causes of
sentinel events (Bouwman et al., 2018). Past research has explored policies and practices of
involving patients and families in these incidents investigations. It is important that these
organizations learn from these events and can improve their quality of care. However, it is
debatable how these sentinel events evaluations should be performed and by whom. Questions
arise regarding openness and transparency - both within interprofessional and with patients. It’s
important to see if patients and their families should be involved in this process, because these
events need to be reflected upon in an open, holistic, and critical manner. This will help optimize
organizational learning and increase quality and safety. This paper aims to investigate how
patient participation adds to organizational learning in health care settings and how this can
improve quality and safety. These insights will help healthcare organizations shape their sentinel
events evaluations and increase the effectiveness of current quality and safety efforts.
Theory
Bate et al. (2008) conceptualized seven challenges regarding quality improvements in
healthcare. One of these challenges is the educational challenge. To improve patient safety and
quality of care, it is fundamental that learning processes are created and sustained to support
persistent progress (Bate et al., 2008). As organizational learning is defined as the process of
creating, retaining, and transferring knowledge within an organization (Clegg et al., 2005; Argote
& Miron-Spektor, 2011), it is important to understand this concept to address this challenge. The
organization has for a long time been defined as something that is stable and a distinct entity
(Clegg et al., 2005). Clegg et al. (2005) argue that organizing is not order, nor a process of
merely ordening. There has been too much focus on rationality, structuring, and controlling,
when irrationality, movement, emotion, and uncertainty also exist (Clegg et al., 2005).
Organizations, therefore, are balancing between two ends of a spectrum: order and chaos, and
much organizing takes place exterior of management tasks (Clegg et al., 2005). Connecting this
with the concept of learning, it is not easy to manage learning because it requires altering
dominant ideas and images of thought.
Date: 6-11-2020
Word count: 1228 including in-text references
Introduction
Healthcare organizations in the Netherlands are obliged to extensively investigate the causes of
sentinel events (Bouwman et al., 2018). Past research has explored policies and practices of
involving patients and families in these incidents investigations. It is important that these
organizations learn from these events and can improve their quality of care. However, it is
debatable how these sentinel events evaluations should be performed and by whom. Questions
arise regarding openness and transparency - both within interprofessional and with patients. It’s
important to see if patients and their families should be involved in this process, because these
events need to be reflected upon in an open, holistic, and critical manner. This will help optimize
organizational learning and increase quality and safety. This paper aims to investigate how
patient participation adds to organizational learning in health care settings and how this can
improve quality and safety. These insights will help healthcare organizations shape their sentinel
events evaluations and increase the effectiveness of current quality and safety efforts.
Theory
Bate et al. (2008) conceptualized seven challenges regarding quality improvements in
healthcare. One of these challenges is the educational challenge. To improve patient safety and
quality of care, it is fundamental that learning processes are created and sustained to support
persistent progress (Bate et al., 2008). As organizational learning is defined as the process of
creating, retaining, and transferring knowledge within an organization (Clegg et al., 2005; Argote
& Miron-Spektor, 2011), it is important to understand this concept to address this challenge. The
organization has for a long time been defined as something that is stable and a distinct entity
(Clegg et al., 2005). Clegg et al. (2005) argue that organizing is not order, nor a process of
merely ordening. There has been too much focus on rationality, structuring, and controlling,
when irrationality, movement, emotion, and uncertainty also exist (Clegg et al., 2005).
Organizations, therefore, are balancing between two ends of a spectrum: order and chaos, and
much organizing takes place exterior of management tasks (Clegg et al., 2005). Connecting this
with the concept of learning, it is not easy to manage learning because it requires altering
dominant ideas and images of thought.
