BY TONI LAPP
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Are most family physicians just not system-oriented? Are they laboring in faulty structures but blind to the fact? This was one theme echoed at the first National Ambulatory Primary Care Research and Education Conference on Patient Safety Sept. 18 - 19 in Chicago.
The AAFP was a sponsor of the conference. While many meetings have focused on patient safety, this was the first national gathering devoted solely to safety in ambulatory primary care settings.
Tools are there
When the Institute of Medicine concluded in its groundbreaking 1999 report, To Err Is Human: Building a Safer Health System, that the know-how already existed to prevent many medical errors, it struck a chord among health care professionals in all settings. Indeed, conference participants frequently cited the report at the patient safety conference.
| Ben-Tzion Karsh, Ph.D. "Maybe it's time to bring people in from an outside perspective and look at the situation from a design point of view." |
Granted, the IOM report looked mainly at hospital-based errors. But some family physicians have come to the same conclusion -- that office-based practices have flaws in their systems of care that work to the detriment of patients.
Perhaps physicians could learn from engineers, said one attendee. "Maybe it's time to bring people in from an outside perspective and look at the situation from a design point of view," said Ben-Tzion Karsh, Ph.D., an industrial engineer from the University of Wisconsin, Madison, who specializes in health care settings.
"We talk too much about errors, not about hazards in design," he said.
When Karsh first visits a site, he takes it all in, he said. What he sees is an information-rich field in which doctors must weigh data coming from many sources: written history, test results, patients and family members.
Models of safety
The concept that existing ideas could be culled from other industries proved to be a frequently voiced refrain at the meeting. What enterprise could health care professionals learn safe practices from?
"UPS," Karsh said. The shipping company has engineered a business design in which packages at various stages in the shipping process can be tracked with pinpoint accuracy throughout the world. And although no one is arguing that patients are like packages, the concept presents an example of using tried-and-true technology.
In her keynote address, Helen Burstin, M.D., M.P.H., director of the Agency for Healthcare Research and Quality's Center for Primary Care Research, spoke of the importance of information technology for patient safety.
"The IOM noted in its report that grocery stores have better technology than doctors," she said, expressing the hope that physicians will soon make use of such technology as bar codes and computerized records.
The patient safety conference arose from discussions among members of the Primary Care Organizations Consortium and staff of the AAFP Developmental Center for Research and Evaluation in Patient Safety in Primary Care, or DCERPS-PC.
Learning from lawsuits
Plenary speaker Gerald Hickson, M.D., associate dean for clinical affairs at Vanderbilt University, Nashville, Tenn., predicted that his role as a malpractice researcher would do little to win him friends in medical practice. But lawsuits offer clues on how to improve the medical system, he said. His research has shown that regardless of specialty, relatively few physicians -- 9 percent -- account for roughly half of complaints.
"We need patients to be our partners," he said. "Our colleagues who are disruptive don't promote that."
And even when a lawsuit is dismissed, it offers a lesson for others, Hickson said. "Poor communicators are sued more often."
He added, "There's been much said about the 'tip of the iceberg.' The unsolicited patient complaint is the iceberg. For every one who complains, 30 will not."
His point? Physicians should not stand by silently while a colleague provides bad care. And this idea needs to be implanted early on, Hickson said. Medical students and residents should be trained to provide feedback to their colleagues.
Plan for the future
Although it was apparent that health professionals need to evaluate and understand primary health care systems better and plan new system designs for the future, it is not yet known whether this conference will be followed by a second conference in 2004.
"We hope that the content and format of this unique meeting will lead to stimulating discussions, new alliances, collaborations and program developments lasting long after we're adjourned," said John Hickner, M.D., M.S., conference chair and director of the AAFP National Network for Family Practice and Primary Care Research.
With sufficient interest among participants, the event could become an annual meeting for those seeking to improve primary medical care delivery through research and education, said Hickner.
Want to learn more?
The proceedings of the National Ambulatory Primary Care Research and Education Conference on Patient Safety will be published online this winter at the AAFP DCERPS-PC Web site. Go to http://www.aafp.org/ptsafety.xml.
To reach writer Toni Lapp, e-mail tlapp@aafp.org.
FP Report is published by the
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Copyright © 2003 by
American Academy of Family Physicians.