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Management: Human resources engaging in performance appraisals (77.3%) and assessment of staff credentials (62.9%). Such practices are now required in the Lebanese hospital accreditation programme, and all hospitals are required to comply with standards relating to performance appraisals and credentialing. However, there is a lack of information on the degree of compliance of hospitals with this standard and the types of performance appraisals being used. Many respondents reported that the strategies adopted by their hospitals were successful in mitigating existing challenges. It is not clear how success was assessed, particularly in that many of the reported strategies did not fully correspond to the reported challenges. This may be an indirect outcome of the qualifications of the respondents and their capacity to fill the position of HR managers. Although some respondents had a masters level degree, the majority reported that it was their working experience that qualified them to fill this role in their hospital. It is worth noting that many of the respondents had dual roles in the hospital which may have affected their perception of the existing challenges and limited their capacity to enforce proper strategies to counter their impact. Conclusion With the upcoming accreditation survey of Lebanese hospitals (2010-2011), there is an opportunity for hospitals to enhance competencies of existing HR managers, and strengthen the HR management component. There is a need to develop a competency framework for the knowledge, skills, attitudes and behavior required for various HR managers. Thorough assessment of what qualifications and experience HR managers have, including all those who work in healthcare organizations, is required. In this context, there is a need to maintain an adequate number of HR managers in healthcare organizations with clearly delineated roles, responsibilities and competencies. One of the major findings of this study was that many respondents combine their duties in the HR department with other roles in the hospital. This comes to exemplify the need for a cadre of competent and well-trained HR managers who can fully assume these roles in Lebanese hospitals and work to continuously improve the status of employees at their hospitals. In this context, middle managers (department heads) can play a vital role in HR management and provide supervisory support. These middle managers can participate in selection/recruitment processes of HR; and they can perform supervisory functions related to HR performance management and appraisal. With regard to retention strategies, proper assessment of the impact of current retention strategies in Lebanese hospitals is required. Such information will be crucial to improving HRM practices at the hospital level, and also in providing lessons for peer hospitals, particularly ones that are not currently implementing any retention initiatives. HRM is a discipline which requires a distinct knowledge base and training. It is not common in certain areas in the health sector at the moment to find professional HR managers, as they are usually promoted from other disciplines. As a result, further education or training is generally required in order to have the necessary competencies to perform well. There is a need to expand HR professional knowledge and competencies for the effective management of human resources in HCOs. There is also a need to increase the pool of competent HR professionals. A new cadre of HR managers will need to be trained and enabled to have real input into operational and strategic decisions about HRM. Our study findings may apply to other countries in the Eastern Mediterranean Region. Another recent study in nine countries found that health systems suffer from poor HRM, resulting in absence of effective recruitment and retention strategies, poor HR planning, lack of proper performance evaluation mechanisms, and absence of a policy for re-licensing of medical staff 5 , and other negative consequences. HRM challenges in HCOs should be valued by policy makers and managers and developing effective HR strategies should become a priority. ❏ Acknowledgements Special thanks to Mr Razmig Markarian for data entry. Competing interests The authors declare that they have no competing interests. Authors’ contributions FE made substantial contributions to the conception, design, as well as analysis and interpretation of results. VT substantially assisted with the literature review, data analysis and write-up of the article. DJ made substantial contributions to analysis of data and interpretation of results. All authors read and approved the final manuscript. Original published in Human Resources for Health 2009, 7:84 doi:10.1186/1478-4491-7-84 http://www.human-resources-health.com/content/7/1/84 References 1. Working Together for Health: The World Health Report 2006 Geneva, Switzerland: World Health Organization; 2006. 2. Global Health Workforce Alliance: Health Workers for All and All for Health Workers, The Kampala Declaration and Agenda for Global Action 2008 [http://www.who.int/entity/workforcealliance/forum/ 1_agenda4GAction_final.pdf]. 3. Kabene SM, Orchard C, Howard JM, Soriano MA, Leduc R: The importance of human resource management in healthcare: a global context. Human Resources for Health 2006, 4:20. 4. El-Jardali F, Jamal D, Abdallah A, Kassak K: Human Resources for health planning and management in the Eastern Mediterranean Region: facts, gaps and forward thinking for Research and Policy. Human Resources for Health 2007, 5:9. 5. El-Jardali F, Makhoul J, Jamal D, Tchaghchaghian V: Identification of Priority Research Questions Related to Health Financing, Human Resources for Health, and the Role of the Non- State Sector in Low and Middle Income Countries of the Middle East and North Africa Region. Research Report Submitted to Alliance for Health Policy and Systems Research 2008. 6. El-Jardali F, Merhi M, Jamal D, Dumit N, Mouro G: Assessment of Nurse Retention Challenges and Practices in Lebanese Hospitals: The Perspective of Nursing Directors. Journal of Nursing Management 2009, 17:453-462. 7. Flynn W, Mathis R, Jackson J: Healthcare Human Resource Management Second edition. Thomson South-Western; 2008. 8. O’Neil M: Human resource leadership: the key to improved results in health. Human Resources for Health 2008, 6:10. 9. Gullatte MM, Jirasakhiran EQ: Retention and Recruitment: Reversing the Order. Clinical Journal of Oncology Nursing 2005, 9(5):597-604. 10. Shields MA, Ward M: Improving nurse retention in the National Health Service in England: the impact of job satisfaction on intentions to quit. Journal of Health Economics 2001, 20(5):677- 701. 11. O’Brien-Pallas L, Duffield C, Hayes L: Do we really understand how to retain nurses? Journal of Nursing Management 2006, 14:262-270. 12. Gould D: Locally targeted initiatives to recruit and retain nurses in England. Journal of Nursing Management 2006, 14:255-261. 13. Dussault G, Fronteira I, Prytherch H, Dal Poz M, Ngoma d, Lunguzi J, Wyss K: Scaling up the stock of health workers: A review International Centre for Human Resources in Nursing, International Council of Nurses, Florence Nightingale International Foundation; 2009. 14. Dussault G, Dubois C: Human resources for health policies: a critical component in health policies. Human Resources for Health 2003, 1:1. 15. Anthony MK, Standing TS, Glick J, Duffy M, Paschall F, Sauer MR, Sweeney DK, Modic MB, Dumpe ML: Leadership and nurse retention: the pivotal role of nurse managers. Journal of Nursing Administration 2005, 35(3):146-155. 16. Force M: The Relationship Between Effective Nurse Managers and Nursing Retention. Journal of Nursing Administration 2005, 35(7-8):336-41. 28 World Hospitals and Health Services Vol. 46 No. 1
Clinical care: Nutrition Nutrition and patient safety a report from the National Patient Safety Agency (United Kingdom) CAROLINE LECKO PATIENT SAFETY LEAD, NUTRITION AND PRESSURE ULCERS PATIENT SAFETY DIVISION, NATIONAL PATIENT SAFETY AGENCY (UK) ABSTRACT: The National Patient Safety Agency (NPSA), established in 2001 as part of the UK National Health Service (NHS), extended it’s portfolio of patient safety programmes to include nutrition in 2006. Since 2006 the focus of the NPSA’s nutrition programme has been to raise awareness of nutrition as a patient safety issue and to encourage healthcare staff to report nutrition related patient safety incidents to the NPSA’s reporting data base, the Reporting and Learning System, to identify key themes and areas for national learning. In the summer of 2009 the NPSA were invited by the International Hospital Federation to join the Improving Infant and Child Food Safety in Health Facilities project as a member of the Advisory Group. This opportunity allowed for the NPSA to share their experience and knowledge of nutrition patient safety themes. Over the last four years the NPSA has been working to raise awareness of nutrition as a patient safety issue. To achieve this NHS healthcare workers have been encouraged to report a wide range of nutrition related patient safety incidents to the Reporting and Learning System. Table 1: Nutrition-related keywords used by the NPSA NG Tube / NG / NGT / N.G.T. Nas*Gastric Oro*Gastric Feeding Tube Feeding Fed / Feed / Food Eat / Eaten / Eating Ate Breakfast Lunch / Brunch Dinner Supper Meal Snack Nutrition / Nutritional Starve / Starving / Starvation Nil By Mouth / NBM / N.B.M. / per orem / per orum Oral Fluids Catering Parenteral Drip Weigh / Weight / Weighting Weighing Scale / Weighing Scales Mal-Nourish / Mal-Nourished / Mal-Nourishment BMI / B.M.I. / Body Mass Index De-hydrate / De-hydrated / De-hydration / De-hydrating Figure 1: Flow diagram demonstrating included and excluded incidents Patient safety incidents reported within the NRLS during 2006 and 2007 (n=1,612,014 ) Incidents captured by nutrition-related keyword search terms in 2006 and 2007 (n=52,675) Randomly generated nutrition-related patient safety incidents from 2006 and 2007 supplied to the CNRG (n=4992) Nutrition-related patient safety incidents identified (n=1433) Nutrition-related patient safety incidents coded into categories Duplicate records excluded (n=11) Patient safety incidents excluded on the basis of not having any nutritional involvement (n=3548) In order to identify the themes and trends associated with these incidents analysis of the data base is undertaken on a regular bases. To date this analysis has been undertaken internally by the NPSA and also by independent commissioned analysis. Analysis undertaken by a Clinical Nutrition Research Group at Kings College London reviewed a random sample of 4992 nutrition related patient safety incidents reported between 2006 and 2007 using key word search terms. Table 1 shows the keywords used to search the data. From the 4,992 incidents analysed 23% were included as nutrition related patient safety incidents. The remaining were excluded on the basis of not having any nutritional involvement or World Hospitals and Health Services Vol. 46 No. 1 29
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