BY JANE STOEVER
Input from patient safety stakeholders -- that's what the Academy wanted, and that's what it got at the Strategic Planning Meeting for Patient Safety in the Primary Care Ambulatory Setting here March 27 28.
Early on, FP Thomas Evans, M.D., of Des Moines, Iowa, representing the National Patient Safety Foundation, stressed the need for the meeting. He noted that, at a mid-March meeting on patient safety, someone asked Carolyn Clancy, M.D., director of the Agency for Healthcare Research and Quality, what was happening with patient safety in ambulatory care. Clancy paused, then said, "The ambulatory arena is in chaos."
Evans, a member of the AAFP Commission on Health Care Services, reported that NPSF's efforts have focused on building awareness about patient safety and providing education on communication between patients and health professionals. Most efforts in patient safety have addressed inpatient concerns, he said. "Specific emphasis on the ambulatory arena has been tough to focus." Evans summed up the patient safety climate in primary care: "True north hasn't been identified."
The group spent two days churning out suggestions for how the Academy could help find true north. The recommendations, after being fine-tuned by the Commission on Quality and Scope of Practice, will be forwarded to the Board of Directors.
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"The common response to managing error is swatting mosquitoes rather than draining the swamp." -- Kerm Henriksen, Ph.D. |
Kerm Henriksen, Ph.D., from AHRQ's Center for Quality Improvement and Patient Safety, issued a warning about patient safety efforts in general: "The common response to managing error is swatting mosquitoes rather than draining the swamp." Too often, frontline personnel are at the mercy of hidden problems, he said, such as poor workspace design, miscommunication, supervisory gaps, clumsy automation, inadequate training.
"We're standing at the front part of the patient safety bridge, getting ready to walk across. Studies are under way; results are starting to come in," said Henriksen. "The Academy should educate its members about latent conditions that lead to adverse events. Convert the rich experiences of the membership into common knowledge."
Internist William Golden, M.D., representing the National Quality Forum, said to expect such things as certification of the ambulatory setting, profiling of group practices, reduction of failure rates and public reporting of adverse events.
"Consumers and purchasers of health care are frustrated with the pace of change and don't understand why there is variation in medical practice," he said. "In the average primary care office, three partners will treat three patients differently."
But patients and their problems are not standardized, said George Shannon, M.D., of Columbus, Ga., a member of the Commission on Continuing Medical Education. "Recognizing errors is retrospective. Primary care doctors practice in a prospective fashion. Our environment is multifaceted, not oriented to a single disease state. The educational opportunities we develop have to be in the real world."
Internist Charles Kilo, M.D., representing the Institute for Healthcare Improvement, said, "Our aim is to improve the performance of practices overall," not just patient safety. "Language has a lot to do with the way people will respond," he said.
Safety is defined by what it's not -- error, said Kilo. "Talking about the absence of accidental injury or reducing the harm from hazards does not make me feel good." He compared the negative focus to betting on which baseball team will be the least worst this summer.
"I urge you to think about reliability," Kilo said, "the ability to provide the right care at the right time for each patient." He added that efforts toward reliability have made enormous progress in the last five years.
The group drafted directions the Academy should consider, including:
To reach writer Jane Stoever, e-mail jstoever@aafp.org.
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