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
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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)
7
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.
10
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)
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 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
Source: Blendon RJ, et. al. Views of Practicing Physicians and the Public on Medical Errors. NEJM 2002;347:1933-40.
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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%)
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 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
Source: Blendon RJ, et. al. Views of Practicing Physicians and the Public on Medical Errors. NEJM 2002;347:1933-40.
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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
Error reportingError reporting
SurveillanceSurveillance
TeamworkTeamwork
CommunicationCommunication
RolesRoles
Customer serviceCustomer service
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Patient Safety in the Ambulatory Care EnvironmentPatient Safety in the Ambulatory Care Environment
Error reportingError reporting
SurveillanceSurveillance
TeamworkTeamwork
CommunicationCommunication
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
CommunicationCommunication
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
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