Cover Story
Providers must give patients a voice in efforts to reduce medical errors
Here's how health care works: providers provide it, consumers consume it. But that equation is starting to shift as concerns over patient safety intensify and a growing number of hospital leaders and physicians say that any solution must involve a more active role for patients.
Today's health care consumers may already be primed for that. Thanks to the Internet and other information outlets, they are not only more knowledgeable about health issues and treatment options than previous generations, but also less inhibited about asking questions. A steady stream of studies and news reports about medical errors has also made them much more wary about how care is delivered.
Providers as a whole may be less eager for change. Many are skeptical about the quality of the health information provided on the Web and about consumers' ability to fully understand even valid information. Moreover, some are reluctant to admit to patients that a potential for error even exists in their care.
Joel Mattison, M.D., was one of those who saw no compelling reason for practitioners to relinquish their paternalistic role-then he became a patient. During hospitalization for surgery, Mattison found that the traditional dominance-subordination medical model often got in the way of patient-centered care by discouraging collaboration and joint decision-making.
"The patient is one of the players in the complex system, yet health care professionals often think of patients in a passive way, as the victims of errors and safety failures," says Mattison, medical director, clinical resource management at St. Joseph's Hospital, Tampa, Fla. "By collaborating with patients and their families, more safeguards can be built into health care processes. When several pairs of eyes are on the case, each with a different perspective, red flags or safety improvement opportunities can be identified more quickly. A certain amount of good redundancy is built into patient-centered care."
Mattison and other proponents say two key factors are necessary for organizations to achieve patient collaboration: a true willingness to partner and candid conversations between providers and patients. It's up to hospital and physician leaders to model behavior that encourages both of those.
Today's informed consumers share a conviction: We have the right to participate as much as possible in our health care experience. Human rights covenants and state and federal laws clearly support that right. However, consumers generally believe that practitioners underestimate their capacity to partner with the health care team.
While putting a patient or two on a hospital service advisory committee is a worthwhile starting point, that alone is clearly not sufficient. A fundamental cultural change must occur if practitioners and patients are to feel comfortable conversing with each other about safety issues.
Leaders at Royal Oak (Mich.) Beaumont Hospital sought to change their culture to ensure that any discussion of potential errors takes place within a blame-free environment. Only when the threat of recrimination is removed can true transparency occur in health care processes so that everyone, including the patient, knows what is going on and why.
"It was essential that the organization first create a patient safety culture before expecting physicians and staff members to accept patients as partners in care," says Steven Winokur, M.D., chief patient safety officer at Beaumont, which was a 2003 finalist for the American Hospital Quest for Quality Award.
Once a blame-free environment is created, the next step is to help practitioners acknowledge the potential for individual mistakes, such as wrong-site surgery, treatment mishaps and medication administration errors. "Practitioners must first let go of their egos or fear of being wrong, and admit that mistakes happen" if they are going to enlist patients in efforts to prevent errors, Mattison says.
Communication is the key to creating provider-patient partnerships. As obvious as that sounds, overcoming longstanding modes of behavior and getting the two sides to talk to each other in an open, straightforward manner is anything but easy.
Freeport (Ill.) Health Network is teaching communication and information-sharing skills to physicians and staff members to prepare them to interact with empowered consumers. The training includes an exploration of attitudes surrounding patient participation and the implications on day-to-day practices, says Cathy Stouffer, FHN's customer service/patient safety officer.
Educating clinical staff is half the challenge. The other half is encouraging consumers to ask more questions about safety issues, and teaching them about when and how to appropriately do so.
"The leadership team should support the development of educational programs that instruct patients and their families on how to collaborate with caregivers to ensure a safe health care experience," says Thomas Royer, M.D., president/CEO of Christus Health, Irving, Texas. In fact, Royer says, the leadership team themselves must actively participate in candid conversations with patients.
"By modeling this behavior, leaders can effectively transform the organization's culture," Royer says. Interactions between senior leaders and patients can take place during hospital rounds or with randomly chosen patient-family focus groups.
Royer suggests asking patients and families questions that include: Are all caregivers identifying themselves to you? Is each person you encounter explaining what they are trying to do for you? Do you feel trust and confidence in your caregivers? Are there times when you have not felt safe? What could we do to make you feel more secure? The information received through these exchanges should be broadly communicated and become part of the patient safety improvement planning process so that appropriate corrective action plans are put into place.
Royer also recommends that every patient be provided with a guidebook that describes major safety hazards and how to prevent mishaps. The guidebook should encourage patients to ask questions and share their pertinent health history with caregivers.
A number of other hospitals and health care systems have undertaken strategies to involve patients in the safety process.
Sentara Healthcare, an integrated health system based in Norfolk, Va., has embarked on a three-pronged approach to improving patient safety that includes implementing major system solutions and minor system changes targeted at a specific issue, changing organizational culture and fostering patient and family participation.
Sentara developed printed safety educational resources as well as a video presentation that explains to patients and families how they can be involved in preventing medical mishaps. Those resources, including the video, are available on the Sentara Web site at www.sentara.com/ patientsafety.
Royal Oak Beaumont developed a brochure titled, "You and Your Caregivers: Partners in Safety," which is given to patients on admission. Physicians and staff members are encouraged to use the brochure to stimulate discussions with patients and their families.
"When patients question the care being provided, rather than becoming defensive, our caregivers are learning to view the interaction as an opportunity to prevent an error," says Beaumont's Winokur. "We have strong leadership support for involving patients in patient safety and the brochure is just one way of showing that support."
Beaumont has also tapped into its community education activities to spread the word about patient safety issues. At the many different courses offered by the hospital, instructors emphasize the importance of partnering with health care providers, informed decision-making and open communication.
A script is provided for the instructors so that a consistent message of the hospital's patient safety philosophy is imparted to course participants. Safety tips are also incorporated into written educational materials.
Now the hospital is exploring ways to expand patient safety education into the 31 different patient support groups that regularly meet at the hospital.
At Tampa's St. Joseph's Hospital, patients receive an information packet that includes "10 Tips to Help Us Keep You Safe." The goal is to help patients understand the potential for errors so they can be more actively involved in preventing them.
Freeport Health Network has undertaken a multifaceted approach to getting patients involved in error prevention. It developed a toolbox of written educational materials that addresses many topics, such as the value of prevention, how patients can be active health care consumers, how to build a positive patient-provider relationship and where to find accurate medical information on the Internet. Those educational materials are available to patients at FHN facilities and are distributed during "road show" presentations at local employer and consumer groups.
The network is also developing written education ideas and tips for area employers to use as paycheck stuffers to serve as constant reminders to their workers about how to receive the most appropriate health care services.
Julianne Morath, chief operating officer and chief nurse executive at Children's Hospital and Clinics of MinneapolisSt. Paul, is outspoken about the need for leadership to instill in staff the importance of collaborating with patients and families throughout the organization. She sees patient-family partnerships as one of four essential elements of a safety culture; the others are accountability, a blame-free environment and continuous learning.
Leaders must set and communicate clear expectations for each of these elements, says Morath, a winner of the John Eisenberg Award for Lifetime Achievement in Patient Safety from the National Quality Forum and the Joint Commission on Accreditation of Healthcare Organizations.
This article was derived in part from Partnering with Patients to Reduce Medical Errors, a forthcoming book from AHA Press (February 2004). The book was edited by Patrice L. Spath (www.brownspath.com), an author and editor of several books on patient safety improvement techniques.
Hospitals & Health Networks You can e-mail your comments to hhn@healthforum.com, fax them to H&HN Editor at (312) 422-4500, or mail them to Editor, Hospitals & Health Networks, Health Forum, One North Franklin, Chicago, IL 60606.
This article 1st appeared in the December 2003 issue of HHN Magazine.
To respond to this article, please click here.
 |
|
Copyright ©2010 Health Forum. All rights reserved. H&HN is published by Health Forum, Inc.
an American Hospital Association information company. |
