RESUMO
OBJECTIVES: There is a growing expectation in health systems around the world that patients will be fully informed when adverse events occur. However, current disclosure practices often fall short of this expectation. METHODS: We reviewed trends in policy and practice in 5 countries with extensive experience with adverse event disclosure: the United States, the United Kingdom, Canada, New Zealand, and Australia. RESULTS: We identified 5 themes that reflect key challenges to disclosure: (1) the challenge of putting policy into large-scale practice, (2) the conflict between patient safety theory and patient expectations, (3) the conflict between legal privilege for quality improvement and open disclosure, (4) the challenge of aligning open disclosure with liability compensation, and (5) the challenge of measurement related to disclosure. CONCLUSIONS: Potential solutions include health worker education coupled with incentives to embed policy into practice, better communication about approaches beyond the punitive, legislation that allows both disclosure to patients and quality improvement protection for institutions, apology protection for providers, comprehensive disclosure programs that include patient compensation, delinking of patient compensation from regulatory scrutiny of disclosing physicians, legal and contractual requirements for disclosure, and better measurement of its occurrence and quality. A longer-term solution involves educating the public and health care workers about patient safety.
Assuntos
Revelação , Erros Médicos , Segurança do Paciente , Políticas , Austrália , Canadá , Comunicação , Revelação/legislação & jurisprudência , Revelação/normas , Humanos , Nova Zelândia , Reino Unido , Estados UnidosRESUMO
After two years at the helm of the Joint Commission, Mark Chassin, M.D., is pressing forward with efforts to turn the Joint Commission into a partner with hospitals and other providers and transform health care into a "high reliability" enterprise along the lines of the aviation and nuclear energy industries. Hospitals & Health Networks asked health care experts and Chassin himself how he's doing so far.
Assuntos
Administradores de Instituições de Saúde , Relações Interinstitucionais , Joint Commission on Accreditation of Healthcare Organizations/organização & administração , Comportamento Cooperativo , Administradores de Instituições de Saúde/organização & administração , Administradores de Instituições de Saúde/psicologia , Administração Hospitalar/normas , Humanos , Objetivos Organizacionais , Garantia da Qualidade dos Cuidados de Saúde , Gestão da Segurança , Estados UnidosRESUMO
A patient-centered model of care has profound implications for the way that care is planned, delivered, and evaluated. Although most leaders in healthcare organizations today embrace the basic tenets of a patient-centered philosophy, they often find that moving toward a patient-centered model requires an unanticipated level of commitment and significant adjustments in organizational structures. In this article, the authors describe how patients and families have been integrated into the care delivery model by involving them in planning, decision-making, and improvement processes at all levels of the organization.