Post on 17-Dec-2015
Human and patient rights in prospect of the medical ethics and the quality and
safety of the health care system
Prof. Isuf Kalo Drejtor i Qendres Kombetare te Cilesise , Sigurise dhe Akreditimit te Institucioneve Shendetesore
isufkalo@qkcsaish.gov.al
Evolution of the people’s rights
18th century: Civil rights (freedom of speech, thought and religion)
19th century: Political rights (voting and election)
20th century: Social rights (education, health, pension)
Marshall, 1963
Patients and health care
1. Health care system
2. Health care delivery
3. Health care quality
Health system goals
Health gains
Responsiveness
Fairness in financing
Level Distribution
Quality Equity
Efficien
cy
}__________ ________
Evolution of health systems
Classical universalism:
All services for all
New universalism:
Only effective interventions for all (less is more…!)
WHO: World Health Report 2000
Oath of Hippocrates -400 B.C
Gratitude from the patients (famous painters )
to their health care providers • DADD: Portrait of Dr. William Orange ,
Portrait of Dr. Morison and Dr.Hood,1853
• Edvard Munch: “The Nurse” (Mss Schacke),
Portrait of Dr. Daniel Jacobson, 1908
• Frida Kahlo: Self portrait dedicated to Dr Eloesser
Self portrait with portrait of Dr Farill, 1951
Portrait of Dr Felix Rey
“In gratitude for the sympathetic treatment …”
V. Van Gogh , 1889
Biomedical Dimension
DOCTOR
Biomedicalknowledge
Signs & symptoms
biomedicaldiagnosis & treatment
diagnosis & treatment
Patient’s hidden thoughts
objective subjectivecomplaints complaints
doctor disease
PATIENT
Quality of health care: patients expectations
• Access to care• Equity , Empathy • Respect for their
preferences • Respect to their dignity,
privacy, confidentiality • Information and
accountability • Physical comfort • Emotional support • Involvement of family and
friends • Continuity
Health systems : What failures?
• Unsafe health system: non transparency on risks and errors
• Dissatisfied patients and healthcare providers
• Lack of accountability to the patients and public
• Inequity on access, practice and outcomes of care
• Corruption
• Ineffective/ obsolete health technologies
• Unjustified waste of resources
• Unaffordable cost to individuals and societies
• Slow progress towards standardization
Present distribution of the various types of intervention
_____________________________________________________________________________
• Za J.A. Muir Gray, Director of Research and Development, NHS Executive, Anglia and Oxford Region.
• „Evidence-Based Healthcare”
Of unknown effect
Do more good than harm
Do more harm than good
Unintentional incidents registered in 2002
Dept. of Int. Care: 223 anonymous registration formsHaukeland University Hospital: 343 “official” errors
Other errors24% (55)
Medical errors21% (47)
Infusion errors10% (23)
Procedures45% (101)
Titles of some BMJ articles -2002
• “Why the Hippocrates ideals are dead ?”
• “Deprofessionalising doctors ?”
• “Why so unhappy?”
• “Dishonest doctors should not continue to practise .”
• “Helping doctors to help themself .
We all must think to find new ways to correct the problems that
we have created with our previous ways of working.
Albert Einstein
Restatement of the Oath of Hippocrates , 1995 –(fragment)
…With PURITY, HOLINESS AND BENEFICENCE I will pass my life and practice my art . …I will neither treat any patient nor carry out any research on the human being without the valid informed consent of the subject …I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from seduction of any patient….
“To write prescription is easy , but to an understanding of people is hard “
Franz Kafka in “Country doctor “
People and health system
• Citizens/Community• Patients/Families• Health Care Providers• Health Administrators• Third Party Payers• Policy Makers
Tec
hn
olo
gy,
Ph
arm
aceu
tica
ls a
nd
Qu
alit
y P
rog
ram
me
The multiple roles of peoplein health systems
Patients and populations
Contributors
Providers
Co
ns
um
ers
Cit
i ze
ns
Financing
Hea
lth
car
e b
eh
avi
ou
rs
Ste
wa
r ds h
i p
Production of goods and services
World Health Report 2000 -
Health Systems: Improving Performance
Partnership in health care is crucial
The equilibrium between doctor and patient
signs & symptoms THERAPY
empowerment
loss of power
mourning - coping
health beliefs
locus of control
diagnosis
suffering
therapeutic education
doctordoctor patientpatient
selection of ttt
Follow up of ttt
Each person has to deal simultaneously with both factors
RECOMMENDATIONSNATIONAL MEDICAL ASSOCIATIONS
QUALITY OF CARE DEVELOPMENT -1994
“National Medical Associations should promote Quality of care as professional
ethical obligation and institute the internal self-evaluative mechanisms among their
members”.
Directions for improvement of the quality in health care provision
• Professional: the way care is delivered- overuse, under-use, misuse.
• Organization: the way care is organized- access, waiting time, communication gap, coordination.
• Relationship: the way care is provided- co-decision-making, empathy, information.
doctor
Doctor Patient
Biomedicalknowledge
Signs & symptoms
Socio-cultural group
Psychosocial & Educationalskills
Biomedical pole
Psycho-educational pole
biomedical, psycho- educationaldiagnosis & treatment
objective subjectivecomplaints complaints
The doctor helps the patient to express his/her:- preconceived ideas: diagn & ttt- health beliefs - experience,- expectation, - fears, coping
diseaseperson
Bio-psycho-social and educational dimensions
Therapeutic Patient Educationin the field of prevention of NCDs
Definition of Therapeutic Patient Education
1. Therapeutic patient education should enable patients to gain and maintain abilities that allow them an optimal management of life with their disease.
2. Therapeutic patient education is therefore a continuous process which has to be systematically integrated in health care.
3. It includes awareness, information, self-care learning and psychosocial support regarding the disease and the prescribed treatment.
4. Its aim is also to help patients and their families to better cooperate with healthcare providers and maintain or improve their quality of life.
empowerment
treatment
psychologyeducationbiomedicine management
health beliefs
evaluationof follow up
management of phone calls
structuredinteractive
visits
detection of complications
diagnosis therapeuticeducation
relapse prevention
therapeutic homework
coping with the illness
locus of control
Long term follow up of patients
Self portrait with Dr Arrieta
• “In gratitude to my friend Arrieta : for the compassion and care with which he saved my life , during acute and dangerrous illness …”
Francisco Goya 1820
Building bridges: professions and the public
• Self regulation
• External assessment
• Patient involvement
• Professional accountability to public
• Public reporting of health care data
Fiona Moss, 2001
“In God we trust”
Everyone else must provide evidence!
Accountability
includes:
• Answerability : the right to receive relevant information and explanation for actions.
• Enforceability: the right to impose sanctions if the information or rationale is deemed inappropriate
The Albanian health system:Under pressure to change
• From the inside - new socio-economic situation - democratization (people’s civil and political rights) - free initiative/market, privatization, competition
• From the outside - regional and European integration - international commitments and standards - globalization (“death of borders” )
National Centre of Quality, Safety and
Accreditation of Health Institutions
Patients sector :• Rights and roles • Information • Therapeutic
education • Organization and
empowerment • Safety
The culture of quality in health care means a state where everyone is:
- aware of the quality concept- believes in it- practises its principles- makes it part of his/her responsibility
All our dreams can come true
if we have courage to pursue them
Walt Disney