Michel Wensing

On the trail of quality and safety in health care

Initiatives to improve patient care have had only limited success. Richard Grol, Donald Berwick, and Michel Wensing call for steps to encourage a new generation of researchers to investigate how to speed up progress

What can patients do to improve health care

ObjectiveTo give an overview of the value of different interventions for increasing the role of individual patients in improving the quality of care provision.

Patient safety in midwifery-led care in the Netherlands.

OBJECTIVE to describe the incidence and characteristics of patient safety incidents in midwifery-led care for low-risk pregnant women. DESIGN multi-method study. SETTING 20 midwifery practices in the Netherlands; 1,000 patient records. POPULATION low-risk pregnant women. METHODS prospective incident reporting by midwives during 2 weeks; questionnaire on safety culture and retrospective content analysis of 1,000 patient records in 2009. MAIN OUTCOME MEASURES incidence, type, impact and causes of safety incidents. RESULTS in the 1,000 patient records involving 14,888 contacts, 86 safety incidents were found with 25 of these having a noticeable effect on the patient. Low-risk pregnant women in midwifery care had a probability of 8.6% for a safety incident (95% CI 4.8-14.4). In 9 safety incidents, temporary monitoring of the mother and/or child was necessary. In another 6 safety incidents, reviewers reported psychological distress for the patient. Hospital admission followed from 1 incident. No safety incidents were associated with mortality or permanent harm. The majority of incidents found in the patient records concerned treatment and organisational factors. CONCLUSIONS a low prevalence of patient safety incidents was found in midwifery care for low-risk pregnant women. This first systematic study of patient safety in midwifery adds to the base of evidence regarding the safety of midwifery-led care for low-risk women. Nevertheless, some areas for improvement were found. Improvement of patient safety should address the better adherence to practice guidelines for patient risk assessment, better implementation of interventions for known lifestyle risk factors and better availability of midwives during birthing care.

Research methods from social science can contribute much to the health sciences

OBJECTIVE Research methods from social science, such as social network analysis, random coefficient modeling, and advanced measurement techniques, can contribute much to the health sciences. There is, however, a slow rate of transmission of social science methodology into the health sciences. This paper identifies some of the barriers for adoption and proposes ideas for the future. STUDY DESIGN AND SETTING Commentary. RESULTS Contributions of social science to the health sciences are not always recognized as such. It may help if the professional profile of social science in the health sciences would be higher and if its focus would be more on making useful predictions. Clinical epidemiologists may assume that their discipline includes all relevant methods and that social science is largely based on qualitative research. These perceptions need to be challenged in order to widen the scope of clinical epidemiology and include relevant methods from other sciences. CONCLUSION New methods help to ask new research questions and to provide better to old questions. This paper has sketched challenges for both social science researchers and clinical epidemiologists.