Patient safety: business or politics? Could be Medicine?
Patient safety and sex have something in common: no one knows how to define them but everyone recognize them when is present. The Patient Safety movement changed some medical landscape dramatically (anesthesia for instance) but now the progression is slow. What are the reasons for that?……
There are in my opinion two medical worlds when we speak about this subject: in United States Patient Safety has a clear implication with the predominant private practice of Medicine. Healthcare systems were aware about the problem with medical errors and they started to change aspects of the organization for a better service to patients but also as a practical rule to reduce the cost of litigation.
In Europe, Health Services are public in general, that means that cost is less visible but they have an strong social control and every medical error has a direct effect on society . Changes in these systems have been based in a logic of “good manners” and in a variable compound of “propaganda”.
Authors like Lucian Leape, Berwick, Provonost and Robert Wachter are authorities in this subject, and their papers and comments are followed by thousands.
The Patient safety movement needs definitions and changes to survive and these changes must be implemented at different levels:
1. The “administrative” dimension: changes such as patient identification, electronical medical records, reducing error of medication, have been started fast, and corporations and governments have been responsible for the change. The outcome has been impresive in some aspects but quality control has not been always performed.
2.The “clinical dimension”: no major changes have been implemented by doctors to increase patient safety. A sense of overconfidence or a “burn-out” environment could be in the base of these situations. An strong tendence is developing theory and practice about how to analyze diagnostic error, how to improve clinical reasoning, even introducing concepts from external disciplines like the “Root-cause Analysis” of failure. This is one of the most critical changes to be made if we want to give real sense to Patient Safety, to incorporate these concepts to the daily clinical practice.
3. Medical Education: Medical schools are key to change things in Medicine. Developing a new curriculum including clinical reasoning, how to learn from errors, bases for decision in general, negotiation and communications techniques ,is a real challenge for the next future of medical education.
4.Patient safety is for patients. They have to play an active role in this system, asking for a complete information, closing the loop of data recovering, expressing their opinions and sharing decisions.
If we want to advance in this important subject, the change must be around these different levels or dimensions, as a coordinated plan in the same way an orchestra plays a symphony.