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Improving Patient Confidentiality Systems in Libya using UK Experience

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Ajaj, Shaban Al-Furgani (2012) Improving Patient Confidentiality Systems in Libya using UK Experience. PhD thesis, University of Gloucestershire.

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AJAJ PhD Thesis May 27.06.2012.pdf - Accepted Version
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Abstract

Patient confidentiality has received much attention in recent years because of the rise in the number of confidentiality breach incidents and the need to improve the provision of health services in general. Patient confidentiality is defined as the patients‟ right to the protection of their personal medical information within health institutions under normal conditions. While literature on the protection of patient confidentiality exists, there is little or no attempt made to use a theoretical model to represent this, and hence, with which to appraise the practice of patient confidentiality in health care systems. The main aim of this research study is to contribute to the development of a model for the protection of patient confidentiality in Libya, using experience and evidence from elsewhere, and also to suggest means to improve confidentiality through the application of lessons from the UK health service. The standpoint taken is a pragmatic one, as the focus is on the utility of the proposed model. There are two principal strands to the research: one concerns the views of experts as to factors that influence patient confidentiality. The second major one is the development of a System Dynamics Model to present the flow of patient data and the places where breaches of confidentiality are likely to occur. These two strands are then considered jointly to provide a basis for conclusions and recommendations of particular relevance in Libya (and perhaps more generally). The data used to identify the main factors that affect the practice of patient confidentiality were collected using two stages: literature review and expert surveys. The first iteration requesting views was sent to experts from Libya, Europe and elsewhere in the field of patient confidentiality, to establish a set of factors that might influence the practice of patient confidentiality. A second iteration followed with selected respondents to rank the relative importance of elements of contributing to two factors, trust and ethics, that were identified in the first expert letter survey. The results from the expert letters indicated that the main factors that influence the practice of patient confidentiality, especially in Libya, were trust, ethics, regulation and technology. The results from the interviews and the focus group showed that the findings of the current research had ecological validity. This is based on the Libyan participants‟ views, which strongly supported the research results as having the potential to improve Libyan patient confidentiality systems by learning from the UK experience. The responses were used to inform the insights obtained from the UK NHS model of patient confidentiality of 2003, which was developed into an innovative simulation using Systems Dynamics Modelling (SDM). Quantitative data to populate the model was drawn from NHS statistics. The model was „validated‟ through personal interviews and a focus group with individuals who had experience in the practice of patient confidentiality in the Libyan health service. The results of the running of the SDM model were also compared to known data to provide a check on validity. The proposed SDM model of patient confidentiality was shown to have ecological validity though the views of medical staff and medical records managers in two major general UK hospitals. The premise was that breaches of patient confidentiality could occur either from (i) human error when dealing with patient medical data within the national health services by staff such as frontline medical staff, doctors and nurses, or (ii) at locations of safe-keeping of patient notes, where medical records managers and others store patient medical data on IT systems, with varying dynamics and volume. The results obtained from the developed model of patient confidentiality are encouraging; they may assist health service managers to minimize breaches of patient confidentiality occurrences. Therefore, the current study proposes a framework and recommendations that can help to improve the protection of patient confidentiality systems in the Libyan health service and assist in delivering a good quality of health care.

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Thesis (PhD)

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