Skip to content Skip to main navigation Skip to footer

Organisational accident model and factors that influence clinical practice

Based on Reason’s work, Vincent 1 developed an organisational accident model which helps to visualize the multiplicity of factors that can be associated to an incident:

Organizational accident model. From Vincent C. Patient Safety. 2nd ed. Singapore: Wiley-Blackwell BMJ Books; 2010.

Considering Vincent’s model, we see that healthcare workers are at the sharp end of the clinical environment, which means that when a major incident occurs one must have a wider approach to understand what has happened. Despite the actions of the individuals could play an important role, their behaviour is influenced by the conditions of their work environment and by broader organisational processes.

At some point of its professional life, a healthcare worker will be involved in an error, which can be a highly stressful experience even when it causes no harm, or it doesn’t reach the patients (near misses). 2

Instead of looking just for the individual directly involved, one must appraise the broader system and what had led to the mistake/lapse/etc. The factors that influence the clinical practice and that can be considered as error producing conditions 3 can be summarized as follows:

Framework of contributory factors influencing clinical practice. From Vincent C, Taylor-Adams S, Stanhope N. Framework for analysing risk and safety in clinical medicine. Br Med J.1998;316(7138):1154–7.

Factor typesContributory influencing factor
Patient factorsCondition (complexity and seriousness)
Language and communication
Personality and social factors
Task and technology factorsTask design and clarity of structure
Availability and use of protocols
Availability and accuracy of test results
Decision-making aids
Individual (staff) factorsKnowledge and skills
Competence
Physical and mental health
Team factorsVerbal communication
Written communication
Supervision and seeking help
Team leadership
Work environmental factorsStaffing levels and skills mix
Workload and shift patterns
Design, availability, and maintenance of
equipment
Administrative and managerial support
Physical environment
Organisational and management
factors
Financial resources and constraints
Organisational structure
Policy, standards, and goals
Safety culture and priorities
Institutional context factorsEconomic and regulatory context
National health service executive
Links with external organisations

  1. Vincent C. Patient Safety. 2nd ed. Singapore: Wiley-Blackwell BMJ Books; 2010.
  2. Waterman AD, Garbutt J, Hazel E, Dunagan WC, Levinson W, Fraser VJ, et al. The emotional impact
    of medical errors on practicing physicians in the United States and Canada. Jt Comm J Qual Patient
    Saf. 2007;33(8):467–76.
  3. Vincent C, Taylor-Adams S, Stanhope N. Framework for analysing risk and safety in clinical
    medicine. Br Med J. 1998;316(7138):1154–7.

Was This Article Helpful?

0
Related Articles
0 Comments

There are no comments yet

Leave a comment

Your email address will not be published.