Download a PDF of the Current Issue 2015 Volume 12 Number 3 July- September
The ten year anniversary of the Institute of Medicine report, To Err is Human: Building a Safer Health System is almost upon us. While much has been done to improve patient safety, improve quality and reduce harm, there is still much that needs to be accomplished. The most recent evolution in the patient safety movement is focusing on building partnerships between healthcare providers and their patients and family members in an effort to clearly define their role as an important member of the healthcare team.
Creating effective partnerships can lead to increased patient satisfaction and improve outcomes by improving the patients’ understanding of their role in their care. Creating these partnerships depends upon first establishing a pervasive culture of patient safety within the organization that supports open, honest two-way communication between patients and care providers. This communication needs to focus on a variety of subjects including patient education; the risks, benefits and alternatives to procedures requiring informed consent; the members of the healthcare team; the active involvement of the patient in their plan of care; disclosure to the patient, or family, when there are adverse events that can impact future healthcare decisions and how to engage the patient in reporting safety concerns they may identify during the course of their treatment.
Patient Education
Effective patient education begins with assessing the patients learning needs, level of health literacy, readiness to learn and identifying any potential barriers to learning.
It is equally important to identify the most effective learning methods for each individual as they will differ from patient to patient. Each patient’s educational needs then need to be incorporated into individualized plans of care to ensure established goals are achieved prior to discharge.
Appropriate medication reconciliation at discharge and clear instructions to each patient about the medications they need to take at home following discharge are another essential part of patient education that minimizes the potential for harm by preventing medication errors that could have long lasting adverse effects on the patient.
One of the Joint Commission’s 2009 National Patient Safety Goals emphasizes the need to encourage patients’ active involvement in their care as a patient safety strategy (Goal #13). In order to actively involve patients in their care, they must first be provided with information about what patient safety initiatives are in place in the facility. Some of these include educating the patient about how they can get involved in their care, how to recognize errors that relate to medications and by encouraging them to speak up if staff or physicians do not follow established practices for hand hygiene, preventing wrong site surgery and methods used for patient identification.
Another 2009 National Patient Safety Goal (Goal #16) focuses on the need to improve recognition and response to changes in a patient’s condition. One of the expectations for complying with this goal is for staff to encourage the patient and family to seek assistance if the patient’s condition worsens. Many facilities across the nation already have processes in place for staff to activate a rapid response team where designated members of the staff are readily available to respond to the patient’s bedside. The role of the rapid response team is to help stabilize a patient’s condition before a medical emergency takes place. The newest safety goal is now asking hospitals to develop a process that empowers the patient, or family, to be able to activate this same level of staff response for rapid assessment and stabilizing treatment. As a result of this new expectation, patients need to be educated about the specific process that is in place, what changes in condition are significant and how they can activate the rapid response team.
Informed Consent
All patients need to be provided with the specific details about any operative or invasive procedure, or any treatment that places the patient at significant risk by the practitioner who will be performing that procedure. In most cases, this is a physician-to-patient communication process where the patient is apprised of the risks, benefits, alternatives to the procedure and the consequences if they choose not to have the procedure performed. This process also needs to include an opportunity for the patient to ask questions of the practitioner who will be performing the procedure and to receive answers that help guide them in making sound health care decisions.
Plans of Care
Involving patients in the development of their plan of care, and daily goals, helps establish their role as an important member of the health care team. This process also enables them to be involved in setting treatment goals and provides them with an opportunity to ask questions of the members of the healthcare team so that they can play a more active role in the ongoing management of their care.
Disclosure
Another area where patients need to be actively involved is when medical errors occur. These errors may relate to medications where incorrect doses or incorrect medications are administered or they may relate to incorrect procedures, retained foreign bodies or wrong site procedures that meet the statutory definition of a significant adverse event. In these situations, a process needs to be in place to facilitate disclosure of the event to the patient by their physician. This process is an important part of a culture of patient safety that provides the patient, or their family, with essential information they can use to make future health care decisions.
Reporting
Developing effective partnerships also involves the need to periodically solicit input from patients about their perceptions of health care quality and safety through patient satisfaction surveys. Whether outside vendors or internally developed survey tools are used, measuring patient satisfaction is one of many ways to identify what’s going well from a patient’s point of view and where they feel the organization needs to focus improvement efforts in order to meet their expectations.
Patients should also be encouraged to report any concerns about quality or patient safety they might have during the course of their treatment. Internal mechanisms may include leadership rounds, dedicated patient safety hotlines, safety suggestion boxes or by providing all patients with the telephone number of an individual to call about their concerns while they are hospitalized. Patients also need to be informed that if they feel that their concerns are not being adequately addressed, they may contact the Agency for Health Care Administration or the Joint Commission directly.
There are many other ways hospitals can partner with patients to improve outcomes and promote patient safety. While the Florida patient safety statutes require that one member of each hospital patient safety committee represent the lay public, patients can also be invited to participate in process improvement teams to provide insight on ways to improve care delivery from a patients’ perspective. Patients are also valuable members of forums, or advisory councils, where ideas about how an organization can improve quality and safety are solicited.
Once you have determined the best approach for developing a partnership with your patients, the next step is to identify measures that can tell you whether or not your efforts to establish this partnership with your patients is succeeding. As with all process improvement initiatives, it is important to capture data before changes are made to determine your current, or baseline, performance, then make the changes necessary to begin the patient partnership and finally capture the data after the new process is in place for a period of time. There are many sources of data that can provide you with information on how you’re doing. Some of these include patient satisfaction data, outcomes data specific to individual performance improvements such as the implementation of family initiated rapid response and patient complaints.
The resources that are available to help guide you in effectively partnering with patients are endless. The Institute for Healthcare Improvement (IHI), the Agency for Healthcare Research and Quality (AHRQ), the Partnership for Patient Safety (P4PS), the National Patient Safety Foundation (NPSF), the LeapFrog Group for Patient Safety and the Joint Commission are a few excellent resources that can provide more details about how to get started on your journey. 
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