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Inviting Patients Backstage

By Jock Hoffman, CRICO

Related to: Ambulatory, Communication, Emergency Medicine, Primary Care, Nursing, Obstetrics, Other Specialties, Surgery

Voluntarily, or under mandate, hospitals are forming Patient and Family Advisory Councils (PFAC)—or simply establishing patient representation within existing committees. As patient advisors gain more influence and access, are hospitals properly prepared to share patient safety data with them?

By October 2010, Massachusetts hospitals must have PFAC programs in place. For some Massachusetts hospitals, official patient advisory roles are well established. For others, compliance with the commonwealth’s new licensure requirement will mark their first such experience. Elsewhere, such efforts are still voluntary, but quite common—precisely because the hospitals recognize the benefits. Having individuals familiar with receiving care offer their perspective—or simply share their own experiences—can help expose risks unseen by those providing care.

To be most effective, the sharing has to be mutual. Hospitals fully committed to the concept will expose patient advisors to organizational vulnerabilities, e.g., patient complaints, incident reports, M&M rounds, and malpractice claims data. Clearly, sharing sensitive details with patient advisors requires adequate confidentiality agreements. Perhaps less clearly, it also triggers the need to properly frame error-related data and event synopses for individuals who may be unfamiliar with the context and vagaries of such information.

A primer for patients asked to process patient safety-related information might include the following considerations:

What is the context? Medical errors, while not uncommon, are rare in relation to overall amount of health care interactions. Data presentations with a numerator of reported errors deserve a denominator reflective of patient encounters.

What is the value of an individual incident? Some adverse events are isolated, and have limited value in identifying any ongoing risks, while other solitary cases can expose significant vulnerabilities.

When did the error occur? Real-time error data (e.g., incident reports, patient complaints) reference recent care practices. Malpractice data and cases—which sometimes aren’t filed for several years after the precipitating event—need to be assessed to determine if the exposed issues are still relevant or unresolved.

Whose story is it? The report of an adverse event or near miss is, typically, one-sided and subject to the bias of the party filing the report. Allegations in malpractice cases are made by the plaintiff (patient); incident reports may be filed by a nurse who disagreed with the physician who disagreed with the specialist; and patient complaint letters can range from fair and balanced accounts of specific personal experiences to diatribes that diverge from the actual care event into irrelevant polemics.

What’s been tried? Because many errors highlight a known systems weakness, remedies may have already been initiated. Patient advisors might not be aware of what’s been tried before, what’s already in place, or what’s on the planning board.

Organizations new to PFACs [pdf] and other mechanisms to add the patient’s eyes, ears, and voice to improving care and safety should find worthwhile any effort necessary to bring patient advisors “up to speed” on the information to which they are being exposed.

January 2, 2010
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