Agenda setting analysis for maternal mortality reduction: exploring influential factors using Kingdon's Stream Model

Background: Maternal mortality is considered as unacceptable death.

Aims: This study aimed to analyse the agenda setting process for maternal mortality reduction policies in nine successful countries in achieving Millennium Development Goal 5 [MDG 5] using the Kingdon's multiple streams theory.

Methods: This comparative study analysed the agenda setting process in nine successful countries which achieved MDG 5. The agenda setting analysed the use of the Kingdon's multiple streams model. To extract similarities and differences in the agenda setting process, the content analysis method, available documents and reports, and the comparative table were used.

Results: The initial attention to the problem of high rate of maternal mortality was different in the studied countries, but MDGs and the countries' official reports were the main driver. Political stability, political will, key person's contribution and legislation were considered influential factors strengthening political stream. International technical or financial support, regional and international conferences, national plans and enabling factors, which provide technical feasibility, were the most important factors influencing the policy stream. Enabling factors included approving regulations and legislation, increased quantity and quality of human resources, organizational structure, service delivery enhancement, infrastructure development, providing medicines and equipment, and strengthening health information system.

Conclusions: The three streams: problem, policy and politics are not separate from each other. Political stability and commitment, having a national plan and benefiting from technical or financial support of international entities was a common feature among almost all the studied countries. The key actions leading to the opening of the window of opportunity were those actions that led to highlighting the problem

Facilitators and barriers to implementing clinical governance: a qualitative study among senior managers in Iran

Health care systems should assign quality improvement as their main mission. Clinical governance [CG] is a key strategy to improve quality of health care services. The Iranian Ministry of Health and Medical Education [MOHME] has promoted CG as a framework for safeguarding quality and safety in all hospitals since 2009. The purpose of this study was to explore perceived facilitators and barriers to implementing CG by deputies for curative affairs of Iranian medical universities. A qualitative study was conducted using face to face interviews with a purposeful sample of 43 deputies for curative affairs of Iranian Medical Universities and documents review. Thematic analysis was used to analyze the data. Five themes were explored including: knowledge and attitude toward CG, culture, organizational factors, managerial factors and barriers. The main perceived facilitating factors were adequate knowledge and positive attitude toward CG, supporting culture, managers' commitment, effective communication and well designed incentives. Perceived barriers were the reverse of facilitators noted above in addition to insufficient resources, legal challenges, workload and parallel quality programs. Successful implementation of CG in Iran will require identifying barriers and challenges existing in the way of CG implementation and try to mitigate them by using appropriate facilitators

Root-cause analysis of a potentially sentinel transfusion event: lessons for improvement of patient safety

Errors prevention and patient safety in transfusion medicine are a serious concern. Errors can occur at any step in transfusion and evaluation of their root causes can be helpful for preventive measures. Root cause analysis as a structured and systematic approach can be used for identification of underlying causes of adverse events. To specify system vulnerabilities and illustrate the potential of such an approach, we describe the root cause analysis of a case of transfusion error in emergency ward that could have been fatal. After reporting of the mentioned event, through reviewing records and interviews with the responsible personnel, the details of the incident were elaborated. Then, an expert panel meeting was held to define event timeline and the care and service delivery problems and discuss their underlying causes, safeguards and preventive measures. Root cause analysis of the mentioned event demonstrated that certain defects of the system and the ensuing errors were main causes of the event. It also points out systematic corrective actions. It can be concluded that health care organizations should endeavor to provide opportunities to discuss errors and adverse events and introduce preventive measures to find areas where resources need to be allocated to improve patient safety.