From cognition to the system: developing a multilevel taxonomy of patient safety in general practice

Author: Kostopoulou, O.

Source: Ergonomics, Volume 49, Numbers 5-6, -6/15 April–15 May 2006 , pp. 486-502(17)

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Abstract:

The paper describes the process of developing a taxonomy of patient safety in general practice. The methodologies employed included fieldwork, task analysis and confidential reporting of patient-safety events in five West Midlands practices. Reported events were traced back to their root causes and contributing factors. The resulting taxonomy is based on a theoretical model of human cognition, includes multiple levels of classification to reflect the chain of causation and considers affective and physiological influences on performance. Events are classified at three levels. At level one, the information-processing model of cognition is used to classify errors. At level two, immediate causes are identified, internal and external to the individual. At level three, more remote causal factors are classified as either `work organization' or `technical' with subcategories. The properties of the taxonomy (validity, reliability, comprehensiveness) as well as its usability and acceptability remain to be tested with potential users.

Keywords: Patient safety; Taxonomy; Human error; Information processing; Performance shaping factors; General practice

Document Type: Research article

DOI: http://dx.doi.org/10.1080/00140130600569038

Affiliations: 1: Department of Primary Care and General Practice, University of Birmingham, Birmingham, B15 2TT, UK

Publication date: 2006-01-01

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