Abstract

This paper expounds the negotiations between the author and the Board of a Regional Health Agency concerning a research project about clinical safety in four Hospital Units in Emilia-Romagna, Italy. Both the methodology and the main results of the research are presented. The Board, well informed about the state of the art of the subject, required a research project which combined direct observation and quantitative parameters able to compare efficiency in the four Hospital Units. This request was satisfied by assuming as the object of analysis both persons observed by the shadowing method and the whole set of their actions classified according to their length, objective, place, etc. In this way, as many "event populations" as the number of observed persons were analyzed by standard statistical measurements. The research gave two main results: first, no "one best way" to achieve clinical safety appears to exist, each hospital unit following its own particular system; second, a connection does exist between the degree of clinical safety and the use of working time: particularly in the most efficient units, the observed persons spend more time in actions aimed at getting long-term improvements; in the less efficient ones, more time is spent reinstating normal routines (i.e. dealing with emergencies).