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Want a savvy participant in your error-prevention program? Put a consumer on your team!

From the May 17, 2000 issue

Lay media feeds public opinion about medical error. While media attention on the issue began to sharpen around 1995, the year 2000 has seen unprecedented scrutiny. What do Americans think? In 1997, a Harris public opinion poll on healthcare safety revealed that most adults felt carelessness and negligence were the most frequent causes of medical error.1 Three-quarters believed that keeping "bad" professionals from providing care would be the most effective solution to prevent medical error. Today, the Institute of Medicine report and media coverage provide clear evidence that a culture of blame still exists. Yet, have we in healthcare done our part to change public opinion?

Don't pass up the opportunity to use this increased media scrutiny to start talking to the public and patients about medical errors and building stronger relationships with the media. While we have been working hard to enhance patient safety within our organizations, we must now come out from behind the scenes to help educate the public about errors, their causes, and how we - providers and patients together - can prevent errors. To start, it shouldn't be hard to find news coverage of a medical error to which you can respond with a press release, commentary, or opposing editorial that explains the likely system-based causes of the error (rather than "bad" professionals) and proactive steps you are taking to prevent a similar error in your facility. Consider collaborative media efforts with local, regional, or state organizations. Get out into the community and talk to the public at local gatherings or host an event in your own facility. Listen to and acknowledge the public's concerns with honesty and demonstrate your commitment to safety with examples of how you have made it difficult for staff to err. Emphasize the things they can do to enhance their own safety. Interestingly, the Harris poll cited above showed that 92% of adults believed that they, themselves, have a positive effect on their own safety. In fact, respondents felt they played a stronger role in their safety above all others in healthcare, except their personal physician. Yet, only one out of ten stated they had taken precautions to ensure their safety. Perhaps their failure to take precautions is due in large part to our failure to provide them with practical ways to participate in their safety and actively encourage their participation without intimidation.

Finally, have you considered including patients/consumers on internal quality improvement and safety initiatives? For example, the Dana Farber Cancer Institute has established a Patient and Family Advisory Council where specific improvement ideas are discussed. One recent initiative yielded surprising results. Staff felt that changing antiemetics from IV to oral therapy would control nausea while reducing the amount of time patients must spend in the clinic. Through the council, they were told that patients were not interested in reducing clinic time. Instead they were concerned that changing to oral therapy would reduce the quality time that they now spend with staff - asking questions and talking about their fears - while IV antiemetic drugs are being administered. The council also receives aggregate information about medication errors and system-based remedies. Dana Farber staff members initially were concerned about patients' reactions to aggregate error data. Remarkably, patients told them that they were well aware that errors occurred and were quite relieved to know that the hospital was aware of them and doing something about it. While you should consult legal counsel before sharing any error data, the benefits have been enormous for the few hospitals that have adopted this courageous practice. If we continue to hide our error reduction efforts from the public, we can't expect to regain their trust. One definition of insanity is doing the same things over and over again and expecting a different outcome. It's time to do something different.

References: 1) Public Opinion of Patient Safety Issues: Research Findings. Prepared for: National Patient Safety Foundation at the AMA. Prepared by Louis Harris & Associates. September 1997.

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