From good intentions to successful implementation: the case of patient safety in Canada

Abstract: Improvements to patient safety have become a major issue on Canada's already crowded health care policy agenda. This paper applies implementation theory to the practical issues involved with the adoption of patient safety reforms. It is based on a review of the literature and official reports on patient safety and on the author's experience as the chair of the Board of Directors of the Manitoba Institute for Patient Safety created in June 2004. The obstacles and possible solutions to advance the patient safety agenda are discussed. While implementation theory was found to provide a general guide, the author's experience leads him to conclude the literature on governance and organizational change offers more practical advice. Sommaire: L'amélioration de la sécurité des patients est devenue une question majeure du programme déjà chargé des politiques en matière de soins de santé. Le présent article applique une théorie de mise en œuvre aux questions pratiques découlant de l'adoption des réformes sur la sécurité du patient. II est fondé sur une étude de publications et rapports officiels sur la sécurité du patient, ainsi que sur l'expérience de l'auteur en tant que président du conseil d'administration de l'Institut pour la sécurité des patients du Manitoba, créé en juin 2004. II passe en revue les obstacles et les solutions possibles à la promotion du programme de la sécurité des patients. Si l'auteur trouve que la théorie de la mise en œuvre fournit un guide général, son expérience le pousse à conclure que la documentation sur la gouvernance et les changements organisationnels offre davantage de conseils pratiques.     

Reactions to inequity

Law and Human Behavior - This article proposes a model for integrating equity theory, a framework for studying the psychology of the legal process, with some tenets of attribution theory. Attempts...     

The use of simulation in criminal justice policy evaluation

The criminal justice system is administered at the local level by many independent agencies and departments, often without regard to each other's objectives and often at the expense of overall effectiveness. This study has attempted to relate the primary system goal of crime control to a set of policy alternatives distributed over each criminal justice sector. Specifically, a simulation model based on the techniques of “industrial dynamics” was developed to evaluate combinations of the following policies: speedy trial, no plea bargaining, and restricted bail. Data obtained from the District of Columbia's criminal justice agencies were used to validate the model. The results of the analysis indicate that the system is basically insensitive to small perturbations, but is susceptible to disruption from large changes in input and procedure. Under the given set of assumptions, continuation of current practices will lead to a gradual deterioration in performance that can only be stemmed by large expenditures on manpower and facilities.     

The Effect of Police Employment on Crime

The effects of police employment on index violent trim rates and index property crime rates are studied using a maximum likelihood technique to estimate two-wave multivariate panel models. Separate analyses are carried out for a sample of 252 U.S. suburbs and for a sample of 269 U.S. cities for the years 1960 and 1970.     

Asymmetric septal hypertrophy of the heart. New findings concerning the possible etiology of sudden deaths in five males

This report describes certain interesting postmortem findings in the hearts of five subjects who died suddenly, silently, and unexpectedly, and in whom the only significant abnormality at autopsy was asymmetric septal hypertrophy (ASH) of the heart. Deep clefts, cystic faults, and dilated vascular channels were not only seen within the septal myocardium in all the hearts, but also within the left ventricular free walls of two hearts. The septal myocardium and the left ventricular free walls of two hearts and the A-V node and His bundle of one heart demonstrated mural and luminal thrombi of several dilated vascular channels. In another heart, foci of cardiocytic myofibrillar degeneration were seen, especially close to narrowed small coronary vessels. Fetal dispersion and fibrosis of the A-V node and His bundle were evident in one heart. These abnormalities in the conducting system and the ventricular myocardium suggest that the hearts of subjects with ASH are not only excellent anatomic substrates for lethal arrhythmias, but also are bound to be hemodynamically impaired. We believe that conditions such as hypoxia, increased oxygen demand by the heart or abnormal sympathetic stimulus may easily trigger fatal arrhythmias in such individuals, thereby causing sudden death.