Patient Safety Workforce Training

Patient Safety Workforce Patient Safety Workforce TrainingTraining

Barry P. Chaiken, MD, MPHBarry P. Chaiken, MD, MPH

Chief Medical OfficerChief Medical OfficerPatient Safety Officers Section Patient Safety Officers Section -- ABQAURP ABQAURP

2

OverviewOverview

Perceptions on Patient SafetyPerceptions on Patient Safety

Workforce TrainingWorkforce Training

3

02468

1012141618

1991 1993 1995 1997 1999 2001 2003*

Change Per Capita In Health Care Change Per Capita In Health Care Spending and GDPSpending and GDP

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.

Percent

Health Care Spending

GDP

* Data for January through June 2003, compared with corresponding months in 2002

8.5%

2.9%

4

0

3

6

9

12

15

18

1985 1988 1991 1994 1997 2000 2003*

Growth in Per Enrollee Premiums and BenefitsGrowth in Per Enrollee Premiums and Benefits

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.

Percent

Premiums per enrollee

Benefits per enrollee

* Data for growth between Spring 2002 and Spring 2003

5

Recommended Care and Quality VariesRecommended Care and Quality Varies

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.

55

68 6554

49 45

0

20

40

60

80

Overall CAD Hypertension Asthma Hyperlipidemia Diabetes

Percent Receiving Recommended Care

6

0%10%20%30%40%50%60%70%80%90%

100%

U.S. Population Health Expenditures

Health Care Costs Concentrated in Sick FewHealth Care Costs Concentrated in Sick Few

1%5%

10%

55%

69%

27%

Source: AC Monheit, “Persistence in Health Expenditures in the Short Run: Prevalence and Consequences,” Medical Care 41, supplement 7 (2003): III53–III64.

50%

97%

$27,914

$7,995

$4,115

$351

Expenditure Threshold (1997 Dollars)

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Physician/Public Opinions on SafetyPhysician/Public Opinions on Safety

0%10%20%30%40%50%60%70%80%90%

100%

QualityProblem

NationalPrority

MandatoryReporting

NationalAgencyNeeded

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.

Physicians

Public

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Public Perceptions on ErrorsPublic Perceptions on Errors

CarelessnessCarelessness

IncompetenceIncompetence

Substandard providersSubstandard providersPhysiciansPhysicians

NursesNurses

Laboratory techniciansLaboratory technicians

Incompetent StarAverage Incompetent StarAverage

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EyeEye--Opening ResultsOpening Results

16%16%11%11%Severe painSevere pain

11%11%6%6%Long term disabilityLong term disability10%10%7%7%DeathDeath

10%10%7%7%Serious ErrorSerious Error42%42%35%35%Medical error self or familyMedical error self or family

PublicPublicPhysiciansPhysicians

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 ListDifferences in Problem List

PhysiciansPhysiciansMalpractice (29%)Malpractice (29%)

Cost of health care (27%)Cost of health care (27%)

Insurance comp. (22%)Insurance comp. (22%)

Medical errors (5%)Medical errors (5%)

PublicPublicCost of care (35%)Cost of care (35%)

Drug costs (31%)Drug costs (31%)

Medical errors (6%)Medical errors (6%)

68% of public did not know what a medical error is

After defined, 50% of public attributed errors to people

(20% for physicians)


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Causes of ErrorsCauses of Errors

PhysiciansPhysiciansNurse shortage (53%)Nurse shortage (53%)

Overwork, stress (50%) Overwork, stress (50%)

PublicPublicPhysician/Pt. time (72%)Physician/Pt. time (72%)

Overwork, stress (70%)Overwork, stress (70%)

No teamwork (67%)No teamwork (67%)

Nurse shortage (65%)Nurse shortage (65%)

Deaths due to errors (53% physicians/60% public)

5,000


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SolutionsSolutions

PhysiciansPhysiciansDevelop systems (55%)Develop systems (55%)

Increase nurses (51%)Increase nurses (51%)

PublicPublicIncrease physician time (78%)Increase physician time (78%)

Develop systems (74%)Develop systems (74%)

Better training (73%)Better training (73%)

Intensivists (73%)Intensivists (73%)


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More DissonanceMore Dissonance

62%62%Publish reportsPublish reports86%86%Keep reports confidentialKeep reports confidential

71%71%23%23%Require error reportingRequire error reporting50%50%3%3%Suspend medical licensesSuspend medical licenses

PublicPublicPhysiciansPhysicians


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OverviewOverview

Perceptions on Patient SafetyPerceptions on Patient Safety

Workforce TrainingWorkforce Training

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Workforce Training ProgramWorkforce Training Program

Introduction to Patient Safety IIntroduction to Patient Safety IIntroduction to Patient Safety IIIntroduction to Patient Safety IIRole of Clinical Staff in Patient SafetyRole of Clinical Staff in Patient SafetyRole of NonRole of Non--Clinical Staff in Patient SafetyClinical Staff in Patient SafetyPatient Safety in the Ambulatory Care Patient Safety in the Ambulatory Care EnvironmentEnvironmentMedication SafetyMedication SafetyJCAHO and Patient SafetyJCAHO and Patient SafetyPatient Responsibility and Patient SafetyPatient Responsibility and Patient Safety

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Introduction to Patient Safety I, IIIntroduction to Patient Safety I, II

Origins of the safety movementOrigins of the safety movement

TerminologyTerminology

Causes of errorsCauses of errors

LeadershipLeadership

Safety organizationsSafety organizations

Management practices for safetyManagement practices for safety

EpidemiologyEpidemiology

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Role of Clinical Staff in Patient SafetyRole of Clinical Staff in Patient Safety

Error reportingError reporting

SurveillanceSurveillance

Clinical IT systemsClinical IT systems

TeamworkTeamwork

CommunicationCommunication

RolesRoles

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Role of NonRole of Non--Clinical Staff in Patient SafetyClinical Staff in Patient Safety



TeamworkTeamwork


RolesRoles

Customer serviceCustomer service

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Patient Safety in the Ambulatory Care EnvironmentPatient Safety in the Ambulatory Care Environment



TeamworkTeamwork


RolesRoles

Customer serviceCustomer service

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Medication SafetyMedication Safety

Medication Medication managmentmanagmentFive rightsFive rightsBarBar--codingcodingClinical IT systemsClinical IT systems

PharmacyPharmacyCPOECPOE

Clinical decision supportClinical decision supportPOC administrationPOC administrationISMPISMP

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JCAHO and Patient SafetyJCAHO and Patient Safety

RegulationsRegulationsNational Patient Safety Goals and RequirementsNational Patient Safety Goals and Requirements

Risk managementRisk management

Sentinel Event Advisory GroupSentinel Event Advisory GroupDatabaseDatabase

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Patient Responsibility and Patient SafetyPatient Responsibility and Patient Safety

Culture of patient safetyCulture of patient safety


Event reportingEvent reporting

WebWeb--based information sourcesbased information sources

Risk managementRisk management

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Board CertificationBoard Certification

ABQAURP (ABQAURP (www.abqaurp.orgwww.abqaurp.org))

Healthcare professionalsHealthcare professionalsCredentialedCredentialed

Continuing educationContinuing education

Work experienceWork experience

NBME examNBME examComputerizedComputerized

Updated regularlyUpdated regularly

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Reality of SystemsReality of Systems

““every system is perfectly designed every system is perfectly designed to achieve exactly the results it gets”to achieve exactly the results it gets”

-- Don Berwick, MDDon Berwick, MDInstitute of Healthcare ImprovementInstitute of Healthcare Improvement

Documents

Patient Safety Workforce Training