From
Medscape PharmacistsEditorial - Safe Medical Treatments: Everyone Has a Role
Henri R. Manasse, Jr., PhD, ScD
[Medscape Pharmacists, 2000. © 2000 Medscape, Inc.]
On March 27th and 28th, 2000, the U.S. Food and Drug Administration (FDA) and the National Patient Safety Foundation (NPSF) cosponsored a workshop, "Safe Medical Treatments: Everyone has a Role." This meeting, which provided a forum for consumers and patient organizations to discuss how to help consumers become more involved in their own medical care, also addressed the issue of safe medical products and how to manage associated, known risks. One of the primary goals of the forum was to share success stories from other consumer movements in the United States and from other countries that have effectively engaged the consumer as agents in their own healthcare.
This workshop did not happen in a vacuum. It was held in the present climate in which there is a window of opportunity to make change. Two events were critical in bringing us to today, where we are witnessing a storming of the Bastille by a public demanding safety first in all settings where healthcare is provided.
Initially, the public became interested in healthcare quality in reaction to the practices imposed by the managed care and insurance industry. Then came the Institute of Medicine (IOM) Report: "To Err Is Human: Building a Safer Health System."[1] The report addresses the enormity and pervasiveness of medical error in the United States. It has served as a wake-up call for all healthcare professionals, the public, and public policy makers.
Not so very long ago, it was common practice for health-system administrators to look the other way when an error or accident occurred in their institution. Confrontation often meant the physician might be offended; outside the walls of the health system, the lawyers waited to pounce. Better to sweep error under the rug -- take a strong defensive position. Learn nothing from your mistakes.
Deficiencies in healthcare quality are common, serious, and systemic. They are largely preventable. Overuse, underuse, and misuse of medical treatment are widespread, and medical errors and adverse events are disturbingly common. The recent IOM Report highlighted the fact that there are between 44,000 and 98,000 hospital deaths per year.[1]
Over time, the focus on enterprise in healthcare has drawn attention away from the covenant with patients. Consider the proliferation of for-profit healthcare facilities and services. Consider that unrealistic reductions and restrictions on care are being implemented in virtually every health facility. Perhaps most important, consider that life and death care decisions today too often are placed in the hands of cost and resource managers instead of the healthcare professions. Managing cost has become the credo in healthcare services.
The traditional commitment to caring in healthcare has been replaced by a mentality that touts marketplace forces as the best path for defining and delivering healthcare. In other words, "no margin, no mission." It seems inevitable that when these 2 sides of the healthcare picture are out of balance, problems ensue. The current all-consuming emphasis on cost and profit is literally preventing healthcare professionals fromfocusing on what traditionally has been and always must be our first concern: the welfare of every patient.
At the moment, there is a unique window of opportunity for us to make our health systems safer places for patients and practitioners. We need to act now to involve the most important actor in the healthcare deliverysystem: the patient. There are several crucial issues that healthcare providers must embrace to ensure that patients participate in their own healthcare as decision makers and managers of risk.
First, providing patients with appropriate knowledge empowers them to become decision makers in their care. Dialogue between the patient and healthcare provider promotes trust, and healthcare professionals need to encourage and assure understanding. Patients should expect nothing less from healthcare providers. As patients and as consumers, they have the right to a higher level of effective communication and a provider who encourages active participation.
Second, risk management is a crucial component of patient participation. We cannot eliminate risk entirely from much of the work in healthcare, but we can work collectively and collaboratively with our patients to effectively manage the inherent uncertainties of healthcare. As a baseline, patients deserve our empathy and should be respected as our partners in our quest for their optimal health. With this baseline, patients can control and manage risks as well as evaluate and balance the benefits of various treatments. The common
objective of reducing risk can be greatly advanced if all of the actors in the system work collaboratively.Third, we must work hard to ensure that this movement toward provider-patient collaboration "is not a flash in the pan." Instead, communication about how to reduce errors needs to be part of an ongoing dialogue. I concur with experts in the field who state that "a safe system is a system that listens."
Fourth, we need to learn how to more effectively interact with patients. It is our duty to find new ways of relating to our patients and reestablish the covenant with patients. We must first recognize that healthcare is a high-risk activity and make patient safety and the management of risk a leadership, management, and payer priority. We must acknowledge and accept risk as our responsibility. In this effort to reduce hazards in healthcare, we must demand a system that listens: a system that allows for open and free communication
between providers and consumers.So I ask you: If not now, when? The time is upon us for change. Consumers deserve the opportunity to be heard and to be treated as colleagues in their own care.
Henri R. Manasse, Jr., PhD, ScD is Chair, National Patient Safety Foundation Board of Directors and
Executive Vice President and CEO, American Society of Health-System Pharmacists.
References
1.Kohn LT, Corrigan JM, Donaldson MS, eds. Institute of Medicine Report: "To err is human: Building a Safer Health System." November 29, 1999. Available at: http://bob.nap.edu/html/to_err_is_human/
Thyroid Home
Back to List of Thyroid Articles