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Document 1 of 1

New graduate occupational therapists' perceptions of near-misses and

mistakes in the workplace
Author: Clark, Michele; Gray, Marion; Mooney, Jane
ProQuest document link
Abstract: Purpose - The purpose of this paper is to explore the perceptions of near-misses and
mistakes among new graduate occupational therapists from Australia and Aotearoa/New Zealand
(NZ), and their knowledge of current incident reporting systems. Design/methodology/approach New graduate occupational therapists in Australia and Aotearoa/NZ in their first year of practice
(n=228) participated in an online electronic survey that examined five areas of work
preparedness. Near-misses and mistakes was one focus area. Findings - The occurrence and
disclosure of practice errors among new graduate occupational therapists are similar between
Australian and Aotearoa/NZ participants. Rural location, structured supervision and registration
status significantly influenced the perceptions and reporting of practice errors. Structured
supervision significantly impacted on reporting procedure knowledge. Current registration status
was strongly correlated with perceptions that the workplace encouraged event reporting.
Research limitations/ implications - Areas for further investigation include investigating the
perceptions and knowledge of practice errors within a broader profession and the need to explore
definitional aspects and contextual factors of adverse events that occur in allied health settings.
Selection bias may be a factor in this study. Practical implications - Findings have implications for
university and workplace structures, such as clinical management, supervision, training about
practice errors and reporting mechanisms in allied health. Originality/value - Findings may enable
the development of better strategies for detecting, managing and preventing practice errors in
the allied health professions.

Full text: Introduction

As with other healthcare professionals, occupational therapists make errors in clinical practice.
Since the Institute of Medicine (IOM) published To Err Is Human: Building a Safer Health System
([9] Kohn et al. , 2000), efforts to reduce adverse events, such as practice errors and improve
patient safety have received increased attention. Significant progress has been made toward
understanding the nature, causes and consequences of near-misses and mistakes in healthcare
areas such as medicine and nursing. However, to date these aspects of quality and safety in
occupational therapy remain a largely under-investigated research area ([16] Mu et al. , 2011).
There is some common ground in defining a near-miss in that it involves an event that could have
caused an accident, injury or illness, but was averted owing to chance or intervention ([8] Iowa
Department of Public Health, 2008; [26] Wagner et al. , 2006). Comparatively, a mistake is any
untoward, undesirable and usually unanticipated event in which harm has occurred to the patient
or harm done to the mission of the organisation ([4] Ebright et al. , 2004). The consequence of
mistakes may be client harm or even death ([5] Gurwitz et al. , 1994; [26] Wagner et al. , 2006).
Collectively, near-misses and mistakes are commonly referred to in the literature as "practice
errors" or "adverse events", as such, these terms are used interchangeably in this article.

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Studies have been undertaken examining practice errors in allied health therapy in rehabilitation,
geriatric and critical care settings ([2] Cochran et al. , 2009; [6] Hahne et al. , 2011; [15] Mu et
al. , 2006). [25] Wade (2009), however, highlighted the "urgent need to investigate harm
systematically" within rehabilitation settings (p393). Several authors have investigated practice
errors specifically within occupational therapy practice. Researchers have used case analysis ([19]
Scheirton et al. , 2007; [12] Lohman et al. , 2008), focus groups ([11] Lohman et al. , 2004; [16]
Mu et al. , 2011) and a national survey in the USA ([15] Mu et al. , 2006) with occupational
therapists working primarily in geriatric or physical rehabilitations settings. Findings from these
studies show that most practice errors occur in the intervention phase of occupational therapy
practice and that they varied from minor to severe ([15] Mu et al. , 2006); often having a moral or
ethical dimension ([19] Scheirton et al. , 2007).
The most common causes of practice errors have been identified as misjudgement, lack of:
preparation; experience; knowledge; and insufficient communication ([15] Mu et al. , 2006; [12]
Lohman et al. , 2008). Factors associated with the frequency, type and impact of error occurrence
include fewer years of practice, workplace attitudes and reporting procedures, and orientation and
mentoring opportunities ([15] Mu et al. , 2006, [16] 2011). Strategies suggested by therapists to
reduce practice errors focused on mentoring and performance competency checks, particularly
for new graduates, as well as addressing the need for cultural and systematic change within the
workplace ([16] Mu et al. , 2011).
Historically, identifying practice errors in healthcare settings has relied largely on self-reporting.
[15] Mu et al. (2006) said that therapists who disclosed practice errors demonstrated more
constructive coping strategies than those who did not and error reporting was influenced by the
organisational culture and response. Mandatory reporting of incidents is soon to be implemented
under a national scheme for the registration and accreditation of health professionals ([1]
Australian Health Practitioner Regulation Agency, 2010). Currently, registration status of
Australian states/territories and other countries vary. However, commencing 1 July 2010, an
Australian national scheme for the registration and accreditation of health professionals was
introduced. Occupational therapists in Australia join the registration scheme in July 2012, bringing
them in line with their Aotearoa/NZ counterparts.
To date, practice errors in Australian and Aotearoa/New Zealand allied health professionals
remains largely unexplored. Given that incident reporting will be mandatory and that lack of
preparation, knowledge and experience play a major role in practice errors, the authors sought to
examine Australia and Aotearoa/New Zealand (NZ) new graduate occupational therapists'
experiences of near-misses and mistakes. New graduates provide an ideal window to study
practice errors, given their recent education, and the potential for harm to both themselves and
others by inexperience ([16] Mu et al. , 2011). The authors proposed to explore:
- How many new graduates had experienced a near miss or mistake in their first year of practice?
- How many had reported this experience?
- What factors affected reporting a near miss or mistake (specifically factors identified in previous
studies such as the experience of workplace supervision, knowledge of reporting procedures and
the perceived encouragement in the workplace to report practice errors)?
As most studies have been drawn from therapists within physical rehabilitation or geriatric
practice settings, the authors also investigated the experience of therapists in several practice
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settings. Given that previous researchers highlighted concerns about the experience of new
graduate therapists working in rural settings, a comparison between metropolitan and rural
practice settings was particularly interesting ([16] Mu et al. , 2011). It is anticipated that
information from the study will be valuable in identifying strategies to reduce practice error
occurrence.
Method
Survey research is characterised by the structured collection and analysis of case data to provide
description and comparison of cases ([3] De Vaus, 2002). Surveys allow an economical and
efficient way of collecting data over a large geographic area from respondents who are thought to
be the best source of accurate information about the topic under investigation ([20] Schofield and
Knauss, 2010). An online survey (www.surveymonkey.com.au) was used to examine work
preparedness and the work environment of new graduate occupational therapists in Australia and
Aotearoa/New Zealand (NZ) in their first year of practice. Near-misses and mistakes was one of
five survey focus areas. In this focus area, participants were asked to provide feedback on several
questions regarding the supervision they received; their experiences (including disclosure) of
situations where a near-miss or mistake had occurred, the event reporting mechanisms that
encourage event reporting. Most questions were in closed-choice format using either a "yes" or
"no" response, or a horizontal rating scale. Three opportunities were provided for open-ended
responses. Participants were invited, if relevant, to indicate the reasons for non-disclosure of an
adverse event and to describe the mistake that they had made or had witnessed (Table I [Figure
omitted. See Article Image.]). Definitions for near-misses and errors were provided to the
participants. Structured supervision was defined as regularly scheduled formal meeting time with
a more senior colleague that provided opportunity for reflection, discussion and learning.
Participants
Participants were new graduate occupational therapists completing their occupational therapy
studies in 2007. Owing to the differing registration requirements across Australian States and
Territories and Aotearoa/NZ, inclusion criteria differed slightly in these two countries. The criteria
for Australian new graduate occupational therapists included those completing their occupational
therapy studies at an Australian tertiary institution. Aotearoa/New Zealand new graduate
occupational therapists were defined as those who had completed their occupational therapy
studies at an Aotearoa/NZ tertiary institution and had current registration and an Annual
Practicing Certificate with the Occupational Therapy Board of New Zealand (OTBNZ). It was
difficult to accurately determine the response rate across Australian non-registered states owing
to missing definitive information about new graduate numbers and survey distribution rates in
Australia. Owing to national registration requirements in Aotearoa/NZ, the new graduate
occupational therapists response rate was 50 per cent.
Procedure
Ethics approvals were gained from an Australian University Human Research Ethics Committee
and the Multi-region Ethics Committee, Aotearoa/NZ. Several recruitment methods were used to
access participants. For Australia, registration boards in Queensland, South Australia and Northern
Territory were involved in contacting their registrants through an e-mail containing the survey.
Occupational Therapy Board, Western Australia staff contacted their registrants by mail. To
capture new graduate occupational therapists in Australian States and Territories that do not
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require registration, staff in OT Associations of these States distributed the survey to their
members by e-mail. Occupational therapy associations were also used in the registered states to
distribute the survey in the final follow up, to maximise the response rate. To capture Aotearoa/NZ
new graduate occupational therapists, the OTBNZ distributed the survey to their new graduate
registrants by email. New graduate therapists were also emailed directly through their degree
awarding institution, Otago Polytechnic and Auckland University of Technology (AUT). The letter
contained a link to the online survey. Correspondence included an information sheet and a letter
inviting participants to partake in the survey. Two follow-up reminder emails were sent through all
the relevant registration boards or associations at two weekly intervals to maximise the response
rate ([3] De Vaus, 2002).
Data analysis
As data collected were primarily quantitative, statistical analyses were performed with PASW
Statistics Grad Pack 18 for the PC ([24] SPSS Inc., 2009). Descriptive statistical analysis was
undertaken initially. The Fisher's exact test was used to examine association between categorical
factors thought most likely to influence the occurrence of near-misses and mistakes. Categorical
factors were knowledge and behaviour (gender, country, geographical location, registration status
and structured supervision), reported near-misses and mistakes; and knowledge and reporting of
these. Given that the categorical data were nominal, a non-parametric test was chosen. The
Fisher's exact test is reported to increase accuracy in results when sample sizes are small ([13]
McDonald, 2008). Content analysis was undertaken for the open-ended responses. Open-ended
responses were sought around, mistake made and witnessed. Response rates for the open-ended
questions were calculated. Responses received were thematically grouped and categorised.
Findings
A total of 228 new graduate participants responded to the survey (Australia n =178, Aotearoa/NZ
n =50); 90 per cent and 96 per cent respectively were female. The median age for both cohorts
was 23 years (range 21-56).
Near-misses
There was no significant difference in near-misses or reporting events between country, age or
gender. When questioned about their intention to disclose a near-miss event, 95.1 per cent from
both Australia and Aotearoa/NZ reported that they would disclose an incident to someone. When
questioned on situations where they felt they had experienced a near-miss that had put a client at
risk, approximately one-fifth (17.9 per cent Australian and 21.4 per cent Aotearoa/NZ
respondents, respectively) had experienced a near-miss (Table II [Figure omitted. See Article
Image.]). Of respondents who had experienced a near-miss, 88.5 per cent of Australian and 88.9
per cent Aotearoa/NZ respondents, respectively disclosed the near-miss to a colleague.
From the Australian respondents, reasons for non-disclosure of the events included fear of being
judged by their colleagues, personal guilt and feeling it was unnecessary. From the Aotearoa/NZ
cohort, one respondent cited their reason for non-disclosure as "near-miss events (e.g. falling) are
a "part of life" for their clients owing to the medical condition they have". Only 84.4 per cent felt
that the workplace encouraged disclosure of near-misses. Furthermore, rural/remote location
appeared to influence total near-misses; with significantly more respondents working in
rural/remote areas having experienced a near miss than their metropolitan counterparts (28.4 per
cent vs 13.4 per cent, p =0.018; Table III [Figure omitted. See Article Image.]).
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Mistakes
Mistakes were reported by both the Australian and Aotearoa/NZ new graduates. As with nearmisses, there were no significant differences between country, age or gender and number and
reporting of mistakes. From the Australian cohort, 7.6 per cent reported making a mistake that put
their client and/or a family member at risk of harm, whilst 9.0 per cent reported making a mistake
that put themselves or a colleague at risk (Table II [Figure omitted. See Article Image.]). From the
Aotearoa/NZ respondents, 9.5 per cent felt they had made a mistake that put their client/family
member at risk, compared to 7.1 per cent who reported making a mistake that had put
themselves or their colleague at risk. The most common mistakes reported by Australian and
Aotearoa/NZ new graduate therapists (that put clients or clients' family at risk) were client falls,
communication errors and allowing an unsafe client activity (question response rate 100 per cent;
Table IV [Figure omitted. See Article Image.]). Common mistakes that put the therapist or
colleagues at risk included not taking appropriate precautions in client situations (that were
potentially dangerous to themselves or colleagues), manual handling errors, communication
errors and car accidents (question response rate 81.3 per cent; Table IV [Figure omitted. See
Article Image.]).
Both groups reported witnessing mistakes by other occupational therapists. Of the Australian and
Aotearoa/NZ respondents similar numbers, 11.0 per cent and 11.9 per cent respectively, felt they
had witnessed a mistake by another occupational therapy colleague (Table II [Figure omitted. See
Article Image.]). The most common mistakes by a colleague witnessed by the new graduates were
failure to complete paperwork/reports and insufficient timely intervention (question response rate
33.3 per cent; Table III [Figure omitted. See Article Image.]). One Aotearoa/NZ respondent
described that following an incident in which equipment left the client vulnerable to falls, they
"talked as a team and found a solution, with everyone well supported". Data showed that 94.4 per
cent of those reporting a mistake would do so again. Similar to the trend observed for disclosing
near-misses, perceptions of workplace encouragement to disclose differed between cohorts. Most
Australian (89.5 per cent) and Aotearoa/NZ (97.6 per cent) respondents felt that staff encouraged
disclosure, however, there was a significant country difference in the identification of events
reporting procedures (78.6 per cent Aotearoa/NZ respondents vs 55.9 per cent, p =0.022).
Furthermore, significantly more respondents who received structured supervision, identified
events reporting procedures in their workplace (66.7 per cent) than those who did not receive
structured supervision (43.5 per cent p =0.005) (Table III [Figure omitted. See Article Image.]).
Practice areas
Near-misses and mistakes were reported to occur in several practice areas (Table V [Figure
omitted. See Article Image.]), with near-misses more common than mistakes. Hand rehabilitation
and aged care experienced the highest percentage of combined near-misses and mistakes.
Twenty occupational therapists working in acute settings (from 49) experienced a near-miss (29
per cent) or mistake (12 per cent). Respondents working in vocational rehabilitation, paediatrics
and mental health reported fewest near-misses and mistakes. From 41 respondents working in
mental health, none reported mistakes and only 7 per cent experienced a near-miss.
Registration status
Most in the sample were required to be registered to practice (79.2 per cent). Of the registered
new graduates, 17.4 per cent experienced a near-miss compared to 21.6 per cent non-registered
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respondents (Table III [Figure omitted. See Article Image.]). This difference was reversed with
mistakes that put a client or their family at risk (9.2 per cent registered and 5.4 per cent nonregistered). However, differences were statistically significant. More respondents working in
registered states/country felt that they were encouraged by their work colleagues to report nearmisses (89.9 per cent vs 75.7 per cent, p =0.033) and mistakes (96.3 per cent vs 77.1 per cent, p
=0.001) than those who did not require registration (Table III [Figure omitted. See Article Image.]).
No significant difference was noted in knowledge of events reporting-procedures for mistakes
between registered and non-registered respondents.
Discussion
Our study shows that newly graduated occupational therapists from Australia and Aotearoa/NZ
experience near-misses and mistakes in practice settings. Findings show that 18.7 per cent
reported experiencing a near-miss and 8.0 per cent reported experiencing a mistake that had put
the client at risk. Several participants (11.2 per cent) also reported witnessing a mistake by
another occupational therapist that put the patient, themselves or a colleague at risk. Most
mistakes reportedly made by therapists related to client interventions; including clients falling and
creating an unsafe situation during intervention for themselves or colleagues. [15] Mu et al.
(2006) also found that most errors occurred during the occupational therapy process intervention
phase.
Disclosing near-misses and mistakes rates was similar between Australia and Aotearoa/NZ
participants. The percentage of therapists reporting a mistake committed by another occupational
therapist was similar to self-reporting percentages. Unexpectedly, country differences were not
statistically significant, nor was there a significant association between gender, age and nearmisses and mistakes. It appears that regardless of demographic factors, new graduates were
similar in their practice errors and reporting behaviour. Non-disclosure of mistakes may hold
safety risks for professionals and clients. Non-disclosure does not facilitate a formal process for
system learning from errors and thus does not reduce the likelihood of similar events in the
future.
One influential factor on near-miss and mistake rates was practice location, with new graduates
practicing in rural/remote areas experiencing significantly more practice errors than their
metropolitan colleagues. Despite experiencing fewer near-miss events, metropolitan new
graduates reported that workplace colleagues were more likely to encourage disclosure compared
to their rural/remote counterparts.
Structured supervision also influenced perceptions and knowledge of near-miss and mistake
reporting. Not surprisingly, structured supervision significantly affected new graduate knowledge
of the events-reporting procedure, with less than half of those not supervised demonstrating
awareness of this procedure. Further, those participants receiving structured supervision felt that
workplace colleagues encouraged reporting of practice errors.
Encouragingly, all respondents reporting a mistake indicated that they would do so again. These
findings have implications for workplace structures such as supervision, induction/training about
practice errors and reporting mechanisms. New graduate occupational therapists have previously
reported the importance of a structured program to support the transition from student to
professional ([21] Smith and Pilling, 2008). Whilst supervising and implementing supportive
environments are important elements in such a program, our study suggests that an environment
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where disclosing and reporting practice errors is encouraged should also be incorporated into
such programs ([7] Herkt and Hocking, 2007). Encouraging disclosure is particularly pertinent to
new graduates working in rural/remote locations, given their perceptions of workplace support for
error disclosure, and the importance of professional support for new graduates in rural positions
([10] Lee and McKenzie, 2003; [23] Steenbergen and Mackenzie, 2004). [16] Mu et al. (2011)
highlighted the need to strengthen orientation and mentoring for newly hired therapists as a key
strategy to prevent and reduce practice errors. This study also highlighted newly graduate
therapists' reporting concerns in rural locations and recommended that students practice
reporting errors during their professional education so that error reporting becomes a professional
socialisation and lifelong learning routine.
Workplace encouragement of practice error disclosure was similar between Australian and
Aotearoa/NZ new graduates, however, registration status had a significant impact on feelings
about being encouraged by their workplace colleagues to report such events. More new graduates
working in registered states/territories/country felt that their workplace encouraged reporting of
mistakes (96.3 per cent), compared to those un-registered new graduates (77.1 per cent). A
similar trend was observed for near-misses (89.9 per cent vs 75.7 per cent). However, the effect
of registration was not observed in events-reporting procedure knowledge. The significant
difference in perceptions of support by the workplace colleagues for disclosing mistakes may
reflect a greater institutional awareness in clinical governance issues, such as the role of
complaints in improving patient safety in jurisdictions with registration compared to those
without. Our findings support the move to national registration through the Commonwealth
Government National Registration and Accreditation Scheme ([1] Australian Health Practitioner
Regulation Agency, 2010).
Negative feelings regarding disclosing practice errors were a common theme throughout the
survey. It is important to highlight the possibility that practice errors may have been witnessed or
experienced but not disclosed owing to their sensitive nature. The nature and types of errors in
occupational therapy are currently poorly understood. A key outcome is how practitioners engage
in reflective practice to learn from and modify their future practice to incorporate preventative
strategies to improve patient safety.
Whilst practice errors ideally should be avoided, this is unlikely. Previous authors have highlighted
the positive learnings resulting from practice errors in relation to instigating greater vigilance and
modifying future practice to prevent such events re-occurring ([2] Cochran et al. , 2009; [11]
Lohman et al. , 2004; [15] Mu et al. , 2006; [18] Scheirton et al. , 2003). Future research should
focus on improving disclosure of practice errors as this has been shown to foster learning, lead to
constructive coping strategies and enhance future practice ([14] Meurier et al. , 1997; [15] Mu et
al. , 2006; [27] Wu, 1999). Leadership and teamwork within the workplace, enabling policies and
procedures at a local team level; fostering change from a "blame and shame" culture to a "just
culture" are important ([22] Sorenson et al. , 2008). A "just culture" encourages open disclosure,
moving from focussing on individual failure to a systems approach, which examines the conditions
under which individuals work. Clinical managers have been identified as critical in developing
ways to prevent or mitigate practice errors ([17] Reason, 2000; [22] Sorenson et al. , 2008).
The study has several limitations. The survey response rate, particularly for Australian new
graduates, was unclear, therefore selection bias may have been a factor and it is likely that the
results represent those who experienced more practice errors. Further, as the response rate to the
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open-ended question around witnessing a mistake by a colleague was low (33.3 per cent), results
around the specific type and situation of these mistakes are indicative only. Despite these
limitations, the study is to our knowledge, the first to examine near-misses and mistakes among
new graduate occupational therapists in Australia and Aotearoa/NZ and is one of the few crosscountry studies in occupational therapy practice.
Conclusion
Our research examined the experiences of new graduate occupational therapists in Australia and
Aotearoa/NZ regarding near-misses and mistakes in practice. Findings from this study have
identified several that influence incident reporting, including practice location (metropolitan vs
rural and remote), structured supervision and a supportive work environment. Despite the
limitations, the findings have implications for university programs and workplace managers and
supervisors around improving new graduate knowledge of quality and safety, and implementing
local policy and practices around open disclosure of errors by allied health professionals. Practice
implications for managers and supervisors include ensuring a "just culture" is developed in the
workplace through mentoring, education and providing structured supervision for newly trained
professionals. These supportive strategies are particularly important in rural and remote settings
were practice errors were more commonly reported. Our findings also highlight areas for further
investigation. The current research focussed on a new graduate population and it would be
beneficial to investigate the perceptions and knowledge of practice errors within the broader
profession. There is also a need for qualitative research to explore in more detail definitional
aspects and contextual factors, such as the types of adverse events that can occur in allied health
settings. Greater knowledge of allied health professionals' near-miss and mistake perceptions and
possibly a classification system for such events in this allied health field, may enable the
development of better strategies for their detection, management and prevention.
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Appendix
About the authors
Michele Clark (BOccThy, BA, PhD) is Acting Assistant Dean (Research) in the Faculty of Health at
the Queensland University of Technology, Brisbane, Australia. She is also Professor of Health
Policy in the Institute of Health and Biomedical Innovation and the School of Public Health at the
Queensland University of Technology.
Marion Gray (BOccTher, MHSc, PhD, GCTT, New Zealand/QLD Registered Occupational Therapist)
is Professor in the School of Health and Sport Sciences, Faculty of Science, Health and Education,
University of the Sunshine Coast, Australia. She is the Discipline Lead and Program Coordinator for
the Occupational Therapy Discipline and a member of the OTAustralia National Professional
Development Committee. Marion Gray is the corresponding author and can be contacted at:
marion.gray@usc.edu.au
Jane Mooney (BSc (Hons)) is currently completing her PhD at the Australian Institute for
Bioengineering and Nanotechnology at the University of Queensland, Brisbane, Australia. She is a
part-time research assistant in the School of Public Health at the Queensland University of
Technology.
AuthorAffiliation
Michele Clark, Institute of Health and Biomedical Innovation and the School of Public Health,
Faculty of Health, Queensland University of Technology, Brisbane, Australia
Marion Gray, School of Health and Sport Sciences, Faculty of Science, Health and Education,
University of the Sunshine Coast, Maroochydore, Australia
Jane Mooney, Australian Institute for Bioengineering and Nanotechnology, University of
Queensland, Brisbane, Australia
Illustration
Table I: Survey questions - excerpts
Table II: Near-misses and mistakes in the first year of practice
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Table III: Mistakes by Australian and Aotearoa/NZ New graduate therapists

Table IV: Influence of location, structured supervision and registration on practice errors and event
reporting in the first year of practice (all respondents)
Table V: Near-misses and mistakes in relation to practice area (all respondents)

Subject: Studies; Reporting requirements; Accreditation; Qualitative research; Therapists;

Perceptions; Disclosure; Managers; Response rates; Patient safety; Supervision; Work
environment; Rehabilitation; Occupational therapy;
MeSH: Adult, Australia, Certification -- standards, Female, Health Care Surveys, Humans,
Inservice Training, Internet, Male, Medical Errors -- statistics & numerical data, Middle Aged, New
Zealand, Occupational Therapy -- education, Occupational Therapy -- methods, Organizational
Culture, Professional Practice Location, Workplace, Young Adult, Health Knowledge, Attitudes,
Practice (major), Medical Errors -- prevention & control (major), Occupational Therapy -- standards
(major), Risk Management -- standards (major)
Location: Australia
Company / organization: Name: Institute of Medicine; NAICS: 541711;
Classification: 8320: Health care industry; 9130: Experimental/theoretical; 9179: Asia & the
Pacific; 5340: Safety management
Publication title: International Journal of Health Care Quality Assurance
Volume: 26
Issue: 6
Pages: 564-76
Publication year: 2013
Publication date: 2013
Publisher: Emerald Group Publishing, Limited
Place of publication: Bradford
Country of publication: United Kingdom
Publication subject: Public Health And Safety, Medical Sciences, Health Facilities And
Administration
ISSN: 09526862
Source type: Scholarly Journals
Language of publication: English
Document type: Feature, Journal Article
Accession number: 24003756
ProQuest document ID: 1412817320
Document URL: http://search.proquest.com/docview/1412817320?accountid=31533
Copyright: Copyright Emerald Group Publishing Limited 2013
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Last updated: 2014-03-10

Database: ABI/INFORM Complete

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