culture and perception on patient safety · 2010. 9. 21. · margarida frança instituto da...
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Margarida FrançaInstituto da Qualidade em Saúde
Portugal
Culture and Perception on PatientSafety
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“... the doctor knowsbest !”
“... health facilitiesalways provide youwith the best care !”
D. H. StamatisD. H. D. H. StamatisStamatis
What paradigms nowadays ?
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We are dealing with :
Very complex and sophisticated organisations
Raising expectations from patients and citizens
New world conditions (citizens mobility, newdiseases, pandemics, … )
Resources limitation
Blaming culture from health organizations (focus onindividualism and professional perfection, non-sharing attitudes, competitive and not used to teamwork ……)
Defensive culture from professionals
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We are dealing with :
Fear attitude from patients and lack of informationfor valid and informed consent and choice
Inconsistent policies and weak leadership fromhealth services
Negative attitudes from media and public
UK: Blunders by Doctors kill 40000 a year
How to achieve health systemsable to deliver safe healthcare and
quality healthcare despite theindividual variation of their
components and intervenient ?
…progress on quality managementdemands a clear understanding of
human motivations and psychologicalneeds from those delivering the healthservices and those receiving them …
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Paradigm Change on HealthQuality Improvement
1970’ssmall area variation analysis
1980’s and 1990’squality improvement methodologies, techniques & tools(ISO, accreditation, EFQM, benchmarking …)
2000’snew dimensions of healthcare quality:
SafetyPatient centeredness/Responsiveness
…measurement alone does not holdthe key to improvement…
… measurement can be worthwhile on improvement ifand always connected to curiosity
– as part of a learning and research culture
and never as a judgment and contingency culture ...
Donald Berwick, 1998Donald Berwick, 1998
Culture as “a complex framework of national,organizational, and professional attitudes and
values within which groups and individualsfunction”
Culture: a complex and abstract reality!
Helmreich, 2000Helmreich, 2000
Safety culture is about good safety attitudes in people butit is also about good safety management established byorganizations,
Good Safety culture means giving the highest priority tosafety,
Good Safety culture implies a constant assessment of thesafety significance of events, and issues, in order that theappropriate level of attention can be given.
What is a Safety Culture ?For Nuclear Industry ….
IAEA, INSAG-4IAEA, INSAG-4IAEA, INSAG-4
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Critical subcomponents of aSafety Culture
by James Reason
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“An organizationalclimate in which peopleare prepared to reporttheir errors and near-
misses”
Five main success factors:
1. Indemnity againstdisciplinary proceedings,
2. Confidentiality,
3. Separation between thebody collecting andanalyzing the reports andthe disciplinary bodies,
4. Effective feed-back topeople reporting,
5. Easy reporting.
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“Atmosphere of trust in which people areencouraged, even rewarded, for providingessential safety-related information
…
but in which people are also clear aboutwhere the line must be drawn betweenacceptable and unacceptable behavior”
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“Capability ofadapting
effectively tochanging
demands.”
Main Success factors:
• Clear leadership
• Autonomy of decision/actionin dangerous situations
• Team work supported onmultidisciplinarycompetences
• Improved communication
• High staff motivation
• High quality investment !
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“The willingness and the competence to drawthe right conclusions from its safety informationsystem, and the will to implement major reformswhen their need is indicated.”
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Care Giver
Care Receiver
Professional standards
Professional codes
Patient Expectations
Patient Rights
Healthcare: a complex relation!
Quality System
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Medical ErrorsSpecial Eurobarometer, EC, Jan 2006
A great majority perceives medical errors as an importantproblem in their country !
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Medical ErrorsSpecial Eurobarometer, EC, Jan 2006
Over half of Europeans - 51% - believe that hospital patientsdo not have a say in avoiding a serious medical error !
London DeclarationPatients for Patient Safety
WHO World Alliance for Patient Safety March 29, 2006
A patient’s visionand commitment.
A call for honesty,openness andtransparency.
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What can be done ?
Use of the same concepts and definitions - a commontaxonomy for patient safety.
Diffusion of the safety concept within the health system.
Create a blame-free environment.
Engage main stakeholders.
Strong leadership and clarity of purpose (resources toaddress safety problems and solutions).
Avoid duplication of initiatives.
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Integrate safety with quality improvement initiatives.
Integrate safety within training of health professionals.
Integrate safety with design of facilities and work conditions.
Engage patients and their families on the safety goals:
What can be done ?
Recommendations of the Committee of Ministers to Member States– Nº. R (2000) 5 on the development of structures for citizen andpatient participation in decision-making process affecting heathcare.
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THE SAFETY CYCLE
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Set up an international agendafor research on patient safety:
To find out HOW and WHY the patient safety models andsolutions reduce errors and adverse events !
What can be done ?
What do we want to get at theend of the day ?
Professional Accountability
Versus
A system view incorporating
professional duties and responsibilities
and patient duties
and social responsibilities
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A COMMON CHALLENGE to create a safety culture
Continuous improvement ofhealthcare services
Models centered on patient/citizen rights and individual needs
Health 0rganizations & Patients
