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

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Thank youfor your attention

Margarida França

mfranca@iqs.pt