Monday, October 25, 2010

A Good Example of Patient Safety and Quality Improvement Processes

I have to admit that I do not have the details of the patient safety and quality improvement protocols in Australia or New Zealand.  But I randomly came across an interesting article that gave me a hint that they are getting it right. The article is titled "'More care needed' in health care".  I am comparing what I read, to what we have in the US.  In the US, there is no mandate that any quality improvement process be applied fairly, or be constructive or transparent.  The majority are spot checks on a targeted physician because of a perceived problem.  The article indicates that "[e]very death" in that hospital , "whether expected or unexpected, was thoroughly investigated and the families kept fully informed, all aimed at making sure similar events are not repeated." What I am reading here are three elements that we do not usually have in many community hospitals in USA:

1.  The "investigation" is performed for every physician when a certain quality indicator (here, it is "death") occurs.  So, this is fairness, as opposed to performing a targeted investigation against a singled-out individual physician.

2.  Making sure that such a problem does not recur.  This is apparently a constructive process to learn a lesson and prevent recurrence, rather than being obsessed with pointing fingers, blaming, punishing, and eliminating the physician altogether from practice.  I assume that there may be instances where harsh measures may be required, but the goal is obviously not to use those extreme measures loosely or as a first-choice.

3.  They talk to patients and families about the event.  This is transparency at its best.  In an open environment like that, you expect continuous improvement of the safety profile and the quality of care.  Since the environment is not punitive, there will be no cover-ups, ideally.

I think we, in the US, can learn from that.  We really need to reform the process.  We owe it to our patients and to our communities.  In the presence of shortages, it is a huge problem to have in place a process that can eliminate excellent physicians from serving the community.  I hope to see the hospital peer review process in the US becoming so well-developed that it would not be used (abused), as so often it does now, as a sham process for economical or political purposes.  If my understanding of the essence of the article is correct, then a big tip of the hat to the quality improvement in Australia (exemplified here by Queensland) and New Zealand (exemplified here by Wanganui)

The above was a comment on the article: 'More care needed' in health care

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