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Accordingly, our aims were to seek senior hospital managers' views on current and innovative strategies to improve hand hygiene, whether failure to adhere to hand hygiene best practice should be conceptualised as a health care error and whether hand hygiene strategies would benefit from penalty-based strategies that focus on individual responsibility.
However, other participants were not comfortable with defining hand hygiene non- compliance as a health care error and rationalised non-compliance as resulting from lack of time and lack of awareness: How could I discipline a staff member… They take shortcuts because they're running behind time or something.
In addition, they were also asked for their views on whether hand hygiene non- compliance could be regarded as a type of health care error and their views on whether there is value in shifting from systems failure to personal accountability to improve compliance.
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Research efforts and policy initiatives in health care errors and injury to health care workers have attracted increasing attention in recent years.
The new program reflects the recommendation of the 2010 Institute of Medicine report The Future of Nursing, which calls for increased nurse leadership to help reduce health care errors and improve quality of care.
10 12 While patient safety research often focuses on defining patient care errors and the patient safety concept as a whole, the perspective of the bedside nurse working at the frontline or 'sharp end' of patient safety practices also merits investigation.
In this country, where iatrogenesis is the third leading cause of death [ 10], increasing patients' participation in their care, reducing health care errors, and ensuring the appropriate use of health care services are among the national aims for improving the quality of health care [ 11, 12].
We observed that reasons for complaints were mainly a result of a surgical or a medical complication, such as in an Australian study [ 28], and "substandard care" (error or delay in diagnosis or treatment, and information or surveillance problem).
This study aimed to identify the main subject areas in which junior doctors' acute care errors occur, and cross-reference the errors with Reason's Generic Error Modelling System (GEMS).
However eye care services, particularly primary eye care, refractive error and low vision, have not been prioritised accordingly.
Furthermore, the total number of clinics offering primary eye care, refractive error and low vision services increased from 96 (10%) to 748 (76%).
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