Transcript Patient Safety Workforce Training

Patient Safety Workforce
Training
Barry P. Chaiken, MD, MPH
Chief Medical Officer
Patient Safety Officers Section - ABQAURP
Overview
 Perceptions on Patient Safety
 Workforce Training
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Change Per Capita In Health Care
Spending and GDP
Percent
18
16
14
12
10
8.5%
Health Care Spending
8
GDP
6
4
2.9%
2
0
1991
1993
1995
1997
1999
2001
2003*
* Data for January through June 2003, compared with corresponding months in 2002
Source: B. Strunk and P. Ginsburg, “Tracking Health Care Costs: Trends Stabilize But Remain High in 2002,”
Health Affairs (Web Exclusive June 11, 2003); B. Strunk and P. Ginsburg, Tracking Health Care Costs: Trends
Slow in First Half of 2003, Center for Studying Health System Change, December 2003.
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Growth in Per Enrollee Premiums and Benefits
Percent
18
Premiums per enrollee
15
12
Benefits per enrollee
9
6
3
0
1985
1988
1991
1994
1997
2000
2003*
* Data for growth between Spring 2002 and Spring 2003
Source: Heffler et al., “Health Spending Projections for 2002-2012,” Health Affairs (Web Exclusive February
7, 2003) for 1985–2001; Employer Health Benefits 2003 Annual Survey, The Kaiser Family Foundation and
Health Research and Educational Trust, September 2003 for 2002–2003.
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Recommended Care and Quality Varies
Percent Receiving Recommended Care
80
60
68
65
55
54
49
45
40
20
0
Overall
CAD
Hypertension
Asthma
Hyperlipidemia
Source: McGlynn et al., “The Quality of Health Care Delivered to Adults in the United States,” The New
England Journal of Medicine (June 26, 2003): 2635–2645.
Diabetes
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Health Care Costs Concentrated in Sick Few
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Expenditure Threshold
(1997 Dollars)
1%
5%
10%
27%
50%
55%
69%
97%
U.S. Population
$27,914
$7,995
$4,115
$351
Health Expenditures
Source: AC Monheit, “Persistence in Health Expenditures in the Short Run: Prevalence and
Consequences,” Medical Care 41, supplement 7 (2003): III53–III64.
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Physician/Public Opinions on Safety
Physicians
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Public
Quality
Problem
National
Prority
Mandatory
Reporting
National
Agency
Needed
Source: Robinson AR, et. al. Physician and public opinions on quality of health care and the
problem of medical errors. Arch Intern Med 2002;162:2186-90.
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Public Perceptions on Errors
Incompetent
Average
Star
Incompetent
Average
Star
 Carelessness
 Incompetence
 Substandard providers

Physicians

Nurses

Laboratory technicians
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Eye-Opening Results
Medical error self or family
Serious Error
Death
Long term disability
Severe pain
Physicians
Public
35%
7%
42%
10%
7%
6%
10%
11%
11%
16%
Source: Blendon RJ, et. al. Views of Practicing Physicians and
the Public on Medical Errors. NEJM 2002;347:1933-40.
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Differences in Problem List
 Physicians
 Public

Malpractice (29%)

Cost of care (35%)

Cost of health care (27%)

Drug costs (31%)

Insurance comp. (22%)

Medical errors (6%)

Medical errors (5%)
68% of public did not know what a medical error is
After defined, 50% of public attributed errors to people
(20% for physicians)
Source: Blendon RJ, et. al. Views of Practicing Physicians and
the Public on Medical Errors. NEJM 2002;347:1933-40.
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Causes of Errors
 Physicians
 Public

Nurse shortage (53%)

Physician/Pt. time (72%)

Overwork, stress (50%)

Overwork, stress (70%)

No teamwork (67%)

Nurse shortage (65%)
Deaths due to errors (53% physicians/60% public)
5,000
Source: Blendon RJ, et. al. Views of Practicing Physicians and
the Public on Medical Errors. NEJM 2002;347:1933-40.
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Solutions
 Physicians
 Public

Develop systems (55%)

Increase physician time (78%)

Increase nurses (51%)

Develop systems (74%)

Better training (73%)

Intensivists (73%)
Source: Blendon RJ, et. al. Views of Practicing Physicians and
the Public on Medical Errors. NEJM 2002;347:1933-40.
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More Dissonance
Physicians
Public
Suspend medical licenses
Require error reporting
3%
23%
50%
71%
Keep reports confidential
Publish reports
86%
Source: Blendon RJ, et. al. Views of Practicing Physicians and
the Public on Medical Errors. NEJM 2002;347:1933-40.
62%
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Overview
 Perceptions on Patient Safety
 Workforce Training
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Workforce Training Program
 Introduction to Patient Safety I
 Introduction to Patient Safety II
 Role of Clinical Staff in Patient Safety
 Role of Non-Clinical Staff in Patient Safety
 Patient Safety in the Ambulatory Care
Environment
 Medication Safety
 JCAHO and Patient Safety
 Patient Responsibility and Patient Safety
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Introduction to Patient Safety I, II
 Origins of the safety movement
 Terminology
 Causes of errors
 Leadership
 Safety organizations
 Management practices for safety
 Epidemiology
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Role of Clinical Staff in Patient Safety
 Error reporting
 Surveillance
 Clinical IT systems
 Teamwork
 Communication
 Roles
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Role of Non-Clinical Staff in Patient Safety
 Error reporting
 Surveillance
 Teamwork
 Communication
 Roles
 Customer service
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Patient Safety in the Ambulatory Care Environment
 Error reporting
 Surveillance
 Teamwork
 Communication
 Roles
 Customer service
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Medication Safety
 Medication managment
 Five rights
 Bar-coding
 Clinical IT systems


Pharmacy
CPOE
 Clinical decision support
 POC administration
 ISMP
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JCAHO and Patient Safety
 Regulations

National Patient Safety Goals and Requirements
 Risk management
 Sentinel Event Advisory Group

Database
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Patient Responsibility and Patient Safety
 Culture of patient safety
 Communication
 Event reporting
 Web-based information sources
 Risk management
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Board Certification
 ABQAURP (www.abqaurp.org)
 Healthcare professionals

Credentialed
 Continuing education
 Work experience
 NBME exam

Computerized

Updated regularly
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Reality of Systems
“every system is perfectly designed
to achieve exactly the results it gets”
- Don Berwick, MD
Institute of Healthcare Improvement
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