3 PURPOSE OF THE STUDY
6.3 Implications for research and practice
This dissertation connected the elements of information culture to adverse events in hospitals. The model developed in this dissertation offers valuable tools to improve current information management practices. Patient safety and information man-agement are concepts that need to be evaluated together. Information manman-agement practices and health information technology cannot be developed without aspects of safety; similarly, patient safety cannot be improved without notifying information management. However, future research related to context is imperative. These results should be tested and confirmed in the other health care environments as well. The following implications for research are identified:
1. Other organizational factors such as work environment, the type of organizati-on culture, and hospital management might influence patient safety outcomes, and their influences on information management incidents should be studied.
2. The interactions between structural elements and work conditions need to be studied to define the most effective factors for the prevention of adverse outco-mes in hospitals.
3. The connection between information management and adverse event types ot-her than those studied in this dissertation needs furtot-her research.
4. This dissertation proved certain associations between information culture and patient safety. The causality suggested in the theoretical framework should be tested using actual adverse event data and measurements of information cul-ture.
It is essential to develop effective strategies to ensure safe information management in hospitals. This study emphasized the information management viewpoint; the find-ings underscore the points that information culture is critical in terms of patient safety, and that a high proportion of the problems in this area are potentially preventable.
Based on the results of this dissertation, the following recommendations for practice are given:
1. Incident reports can be used to identify information management practices that are threats to patient safety, but the quality of the reports must be evaluated and monitored. Both the quantitative portion and associated narratives include information needed to make these reports actionable for improving safety.
2. An organization’s guidance on electronic documentation, and use and transfer of information should be informative and support safe information manage-ment practices. Special attention should be paid to the formal workarounds that are accepted by management and create a possibility of failure.
3. Documentation of patient care is the most important factor in information mana-gement in order to secure patient safety. The content of documentation should be structured, and the critical elements should be clearly defined. The use of copy-and-paste has to be avoided, as should duplicate documentation in mul-tiple systems.
4. Information transfer seems to be the most vulnerable phase in the process. Ac-curate documentation ensures that the needed information is available, but the content of transferred information needs to be defined. Similarly, the situations where information transfer is needed, and who will transfer it, should be clearly defined.
5. Hospital management has to take a stronger role in the development of safe information management practices in cooperation with health professionals.
The understanding of complexity of the information management process is required in development.
7 CONCLUSIONS
This study contributes new knowledge about the elements of information culture and their associations with information management incidents and certain patient safety incidents. In addition, it produces recommendations for the development of safe information management practices in hospitals.
The development of safe and effective information management practices requires the identification of the types of information, levels in where information processing occurs, and the phases of the IM process. This study focused on clinical information management and concluded that information management incidents are associated with medication administration errors, complaints from patients and their families, and information-related adverse events. Four main types of information management incidents were identified: documentation errors, information delay, information lost during shift change, and information lost during patient transfer. Of these, documen-tation errors had the strongest connection to other incident types and patient safety incidents. This indicates the importance of documentation practices, but also the need for organizational guidance about documentation. The existence of organizational guidance was associated with all other variables, meaning that accurate and updated guidance on information management practices is important in terms of patient safety.
The big challenge is to develop clear guidance and implement it in practice.
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