Table 2 Examples of the distinction between proximal and distal obstacles to patient safety identified by staff
Proximal obstacles | Distal factors |
|---|---|
Shortage of skilled nursing staff (e.g. in operating theatres) | -Human resource shortages nationally |
-Few opportunities for specialist training or updating of skills | |
-Human resource management policies | |
-High turnover of staff, associated with staff dissatisfaction | |
Shortage of material resources (e.g. sterile drapes) | -Non-functional equipment due to lack of trained maintenance staff (e.g. broken autoclaves) |
-Infrastructure failures (lack of electricity to power autoclave or water supply to ensure reliable supply of sterilised equipment) | |
-Lack of access to and/or budget for materials and parts (nationally and/or locally) | |
Lack of access to necessary drugs (e.g. antibiotics) | -Patient poverty |
-Lack of access to or budget for desired drugs at national level | |
-Problems with storage and accessibility of drugs -Delays and other problems with procurement processes |