Patient Protection 1st Top Ten

Top Ten List: Why Hos­pi­tals Need to Make Patient Pro­tec­tion 1stSM  — and Why Patients and Fam­i­lies Need to Insist Upon It

Rea­son # 10     It’s not just a patient in that bed. It’s a sacred trust.

When a hos­pi­tal assumes respon­si­bil­i­ty for a patient, the insti­tu­tion — and those who per­form care with­in it — enter into a sacred trust with that patient and fam­i­ly. We have a right to expect that those respon­si­ble for our care will do every­thing they can to pro­tect us.

No patient or fam­i­ly can ever be expect­ed to know all the evidence-based rec­om­men­da­tions and best prac­tices that should be fol­lowed for our safe­ty, such as use of surgery check lists and “time outs” pri­or to an oper­a­tion, com­put­er physi­cian order entry (CPOE), and rapid response teams avail­able at the request of the patient and fam­i­ly. But we are enti­tled to expect that providers and pro­fes­sion­als will know what these prac­tices are, and that they will fol­low them. Patient safe­ty lit­er­a­ture con­stant­ly reminds us that most hos­pi­tal errors could have been pre­vent­ed if a few sim­ple steps had been tak­en, like wash­ing hands, or read­ing the chart before admin­is­ter­ing med­ica­tion, or con­firm­ing that it was the right patient for the sched­uled surgery.

True cham­pi­ons of patient safe­ty in the hos­pi­tal set­ting ask, “Is this how I would like my father or moth­er, my sis­ter or broth­er, my wife or hus­band, my son or daugh­ter, to be treat­ed?”

Health­care providers that make Patient  Pro­tec­tion 1stSM are dri­ven by the real­iza­tion that the most impor­tant per­son in the world is the patient before them right now.

Rea­son # 9    Life-threatening hospital-acquired infec­tions nev­er send a call­ing card before they show up in a patient’s room.  But patients and fam­i­lies will always know after they’ve arrived. 

Hospital-acquired infec­tions claim at least 100,000 lives in the Unit­ed States and Cana­da every year, and leave a mil­lion more patients sick­er than they were at admis­sion. 

It takes con­stant­ly vig­i­lant, hygiene-proactive care providers, and a strong­ly enforced safe­ty cul­ture, to make the arrival of these silent killers unwel­come.

Health­care providers that make Patient Pro­tec­tion 1stSM antic­i­pate infec­tions before they arrive and take effec­tive steps to pre­vent them at every lev­el, from hos­pi­tal main­te­nance and clean­ing to post-surgery care.

Rea­son # 8   You’re a health­care pro­fes­sion­al who has a prob­lem remem­ber­ing to per­form hand hygiene before and after patient con­tact. Real­ly? 

Stud­ies by the Cen­ters for Dis­ease Con­trol (CDC) and World Health Orga­ni­za­tion (WHO) have con­sis­tent­ly shown hand wash­ing by health­care work­ers to be one of the most effec­tive strate­gies in com­bat­ing infec­tions in the hos­pi­tal set­ting.  Yet com­pli­ance with this vital patient safe­ty tool is seen by experts as “dis­ap­point­ing­ly low” and far from where it needs to be in most hos­pi­tals.  One major U.S. study report­ed hand hygiene com­pli­ance in hos­pi­tals to be 36 per­cent on aver­age.

For years, lead­ing health­care author­i­ties have been using multi-million dol­lar aware­ness cam­paigns —  with posters, con­fer­ences and learned papers — to encour­age hand wash­ing com­pli­ance. The mes­sage is being sent, but it’s not being received well enough among some health­care providers.

Health­care providers that make Patient  Pro­tec­tion 1stSM ensure that hand wash­ing prac­tices are rig­or­ous­ly fol­lowed with­out excep­tion.  And they don’t need push­ing, prod­ding and plead­ing to do it.

Rea­son # 7     I’m more than just a hos­pi­tal num­ber.

Beneath that hos­pi­tal gown and mass of tubes lies a ful­ly unique human being whose life has been a pre­cious gift. That “patient” is a real per­son who touch­es the lives of count­less oth­ers. Her or she has an intrin­sic val­ue that makes them wor­thy of being treat­ed with dig­ni­ty and respect, regard­less of age, socio-economic sta­tus or med­ical con­di­tion.

Yet patients and fam­i­lies who have expe­ri­enced harm fre­quent­ly report that they were treat­ed as an incon­ve­nience or worse, and not as if they real­ly mat­tered.  Age is often a fac­tor in these sit­u­a­tions.  Many fam­i­lies claim that their loved one’s con­cerns, or chances of recov­ery, were not tak­en seri­ous­ly or that they seemed to be writ­ten off alto­geth­er. A sense of aban­don­ment is not uncom­mon among the emo­tion­al harm that patients and fam­i­lies voice.  Prac­ti­tion­ers of care need to see beyond stereo­types and guard against the just-another-patient syn­drome.

Patients, and their fam­i­lies where that is appro­pri­ate, need to be at the cen­ter of care decision-making.  We are enti­tled to know that we have the right to refuse treat­ment or care and that when care is deliv­ered, such as tests and med­ica­tion, it is based on patient/family con­sent fol­low­ing full dis­clo­sure of the risks and ben­e­fits.

Health­care providers that make Patient  Pro­tec­tion 1stSM nev­er fail to respect the inher­ent unique­ness of the per­son they are car­ing for. They take steps to embed that recog­ni­tion in their cul­ture and in the sys­tem of care that is deliv­ered to every patient of every age.

Rea­son # 6    Com­pas­sion, kind­ness and respect can be as potent as any drug. When they are miss­ing, the out­come can be as dan­ger­ous as a dis­ease.

Research has shown that val­ues like com­pas­sion and kind­ness have a pos­i­tive effect on patient out­comes. And when these val­ues are ignored by mem­bers of the care team, patients often feel a sense of aban­don­ment and dis­cour­age­ment that can presage sig­nif­i­cant down­turns in their con­di­tion.

Com­pas­sion, kind­ness and respect are part of what we call The Lor­raine Fin­lay Heal­ing  Health­care VirtuesSM .They are what patients and fam­i­lies have time and again report­ed to be the val­ues that are para­mount in fos­ter­ing safe care and emo­tion­al com­fort. They are named after the moth­er of The Center’s founder, who demon­strat­ed these virtues in the care she deliv­ered as a nurse for many decades begin­ning in World War II. Unfor­tu­nate­ly, these same virtues were glar­ing­ly absent when she need­ed them, with hor­rif­ic con­se­quences that result­ed in an epi­dem­ic of avoid­able med­ical harm at two hos­pi­tals.

These virtues come in many forms, from show­ing respect to patients and fam­i­lies by incor­po­rat­ing poli­cies that see health­care pro­fes­sion­als knock on the patient’s door before enter­ing, intro­duce them­selves by name and make eye con­tact in the process, and explain their pur­pose in being there.  It also refers to respect for the patient’s pri­va­cy and dig­ni­ty, includ­ing the type of gowns and cloth­ing used in the hos­pi­tal set­ting. When health­care pro­fes­sion­als need to have a dis­cus­sion with the patient and/or fam­i­ly, it should occur on the same phys­i­cal lev­el, max­i­miz­ing eye con­tact and using clear, but non-threatening and respect­ful, lan­guage.

Health­care providers that make  Patient  Pro­tec­tion 1stSM rec­og­nize these virtues as being as essen­tial to the care and heal­ing of a patient as a ster­ile ban­dage after surgery. They strive to inte­grate these heal­ing virtues through­out the entire care par­a­digm and take cor­rec­tive actions when they have been com­pro­mised.

Rea­son # 5   Don’t call fam­i­lies “vis­i­tors.”  We are full part­ners in the care team. 

While it is the patient who is receiv­ing care, the real­i­ty is that often their fam­i­ly is hos­pi­tal­ized, too.  Patients want and need the sup­port of fam­i­ly mem­bers. Research has shown that fam­i­ly involve­ment is a key fac­tor in cre­at­ing more pos­i­tive out­comes for patients. Fam­i­ly mem­bers are an inte­gral part of the care team. As experts on our loved ones, we are in a unique posi­tion to sense changes in the patient’s con­di­tion and to bring con­cerns for­ward in a time­ly man­ner.

Hos­pi­tal poli­cies and prac­tices need to rein­force prin­ci­ples of patient- and family-centered care at every stage from admis­sion through dis­charge. They need to embrace the role of fam­i­lies, be pre­pared to share infor­ma­tion with them, col­lab­o­rate with them in devel­op­ing and fol­low­ing a plan of care, and sup­port them ful­ly in their hos­pi­tal par­tic­i­pa­tion.

Providers that are tru­ly patient- and family-centered know that the hos­pi­tal­iza­tion of a loved one can be among the most trau­ma­tiz­ing and stress­ful peri­ods ever expe­ri­enced by a fam­i­ly. The health of fam­i­ly mem­bers them­selves can be placed at risk from exhaus­tion, work strains and finan­cial chal­lenges that arise when a loved one is sud­den­ly hos­pi­tal­ized.  

Flex­i­ble access hours that allow care­giv­ing fam­i­lies to be with their loved ones when they want and need to be is an impor­tant start­ing point in pro­vid­ing fam­i­ly sup­port. But lit­tle things, like a reas­sur­ing ges­ture, a friend­ly smile, find­ing a com­fort­able chair for some­one who has been stand­ing for a while — these can make a huge dif­fer­ence in giv­ing fam­i­lies the sup­port we need to help a loved one through their hos­pi­tal jour­ney.

Health­care providers that make Patient  Pro­tec­tion 1stSM under­stand the crit­i­cal role fam­i­lies play in the care and recov­ery process. They walk the talk when it comes to prin­ci­ples of patient- and family-centered care, and encour­age the full par­tic­i­pa­tion of fam­i­lies in rounds, dur­ing nurs­ing shift changes and in every step of care deliv­ery.

Rea­son # 4   Open­ness and trans­paren­cy are signs of a healthy hos­pi­tal cul­ture. They are also indis­pens­able to patient health.

Patients are eth­i­cal­ly and legal­ly enti­tled to infor­ma­tion about their health and the risks they face. This includes the right to give, or with­hold, con­sent for treat­ment, tests and med­ica­tion based on full dis­clo­sure of the facts and risks involved. This also includes time­ly access to patient med­ical records. Ensur­ing that patients are ful­ly informed, and are treat­ed as full part­ners in their care, enhances their sense of engage­ment and adher­ence to treat­ment reg­i­mens.

A sec­ond branch of dis­clo­sure in the hos­pi­tal set­ting involves steps to ensure that patients and fam­i­lies are aware of the risk of break­downs in patient safe­ty pro­ce­dures. That dis­cus­sion, and infor­ma­tion about the real­i­ty of hos­pi­tal errors, needs to take place in an ori­en­ta­tion process at admis­sion. Patients and fam­i­lies need to be encour­aged to be watch­ful, to ask ques­tions and to take steps to make any con­cerns or com­plaints ful­ly known.

There needs to be a legit­i­mate 24/7 process for report­ing and address­ing con­cerns and com­plaints in a good faith man­ner, and the process to set any for­mal review or redress in motion needs to be clear­ly spelled out and con­sis­tent­ly avail­able in a vari­ety of forms to patients and fam­i­lies. This is an essen­tial way for a provider to acknowl­edge and give force to their duty to pro­tect patients from harm, includ­ing emo­tion­al harm, and to deal with it when it occurs.

Health­care providers that make Patient  Pro­tec­tion 1stSM know that they have a duty of can­dor to all patients and fam­i­lies in ensur­ing they have the infor­ma­tion they need to engage in their care, to pro­tect them­selves from harm and to act when it occurs.

Rea­son # 3    A com­plaint is not a dec­la­ra­tion of war and should not be treat­ed that way by the hos­pi­tal. It is an oppor­tu­ni­ty to learn and to demon­strate the best val­ues that guide health­care providers.

Evi­dence sug­gests that few patients actu­al­ly make a for­mal com­plaint and are reluc­tant to do so even if they feel jus­ti­fied. But when a com­plaint is made, it is with the expec­ta­tion that it will be dealt with fair­ly, objec­tive­ly and in good faith. Research also shows that com­plaints can be pre­dic­tors of harm to come and there­fore pro­vide clin­i­cal teams with a red flag that allows them to height­en vig­i­lance and patient care prac­tices.  

Unfor­tu­nate­ly, in many cas­es patients and fam­i­lies report that the mis­sion of provider com­plaint units (some­times called patient rela­tions offices or patient and fam­i­ly expe­ri­ence depart­ments) is to mol­li­fy patients or to avoid bad pub­lic­i­ty or lit­i­ga­tion rather than deal­ing with the effects of med­ical errors or harm on the patient and fam­i­ly. Com­plaint process­es can also be cum­ber­some, opaque and are typ­i­cal­ly inac­ces­si­ble dur­ing evenings, week­ends and hol­i­days, when patients and fam­i­lies often need access to them.

As a result, the expe­ri­ence of many patients who have filed com­plaints has not been good. Indeed, research shows that often patients and fam­i­lies were more trou­bled by the way a com­plaint was han­dled, and the emo­tion­al harm that result­ed, than by the under­ly­ing med­ical error that led to the com­plaint being ini­ti­at­ed.

Deal­ing with com­plaints on the basis of a hospital’s core val­ues of hon­esty, com­pas­sion, open­ness and kind­ness, and its pro­fes­sion­al com­mit­ment to do no harm, gen­er­al­ly finds a pos­i­tive response on the part of patients and fam­i­lies. They are not seek­ing to pun­ish or embar­rass if treat­ed open­ly and in good faith. Rather, they are seek­ing answers, an indi­ca­tion that learn­ing has occurred and that an apol­o­gy will be offered for the harm that has been done.

Health­care providers that make Patient  Pro­tec­tion 1stSM  deal hon­est­ly and open­ly with com­plaints and embrace the oppor­tu­ni­ties for learn­ing and improve­ment they pro­vide.

Rea­son # 2      If you harm me, you owe me an apol­o­gy — and a lot of help and com­pas­sion to help me, and my fam­i­ly, heal.

To err is human; to cov­er up is not. The will­ing­ness of hos­pi­tals and clin­i­cians to take own­er­ship of an error, and to attempt to heal all those affect­ed by it, is an irrefutable oblig­a­tion of every provider of care.  But in too many patient and fam­i­ly expe­ri­ences, hos­pi­tals seek to evade account­abil­i­ty for the harm they have caused.

As the high­ly respect­ed Agency for Health­care Research and Qual­i­ty (U.S. Depart­ment of Health and Human Ser­vices) notes, 

When a patient is a vic­tim of an error, hos­pi­tals have tra­di­tion­al­ly fol­lowed a ‘deny-and-defend’ strat­e­gy, pro­vid­ing lim­it­ed infor­ma­tion to the patient and fam­i­ly and avoid­ing admis­sions of fault. This response has been crit­i­cized for its lack of patient-centeredness, and in response, some insti­tu­tions have begun to imple­ment ‘communication-and-response’ strate­gies that empha­size ear­ly dis­clo­sure of adverse events and a more proac­tive approach to achiev­ing an ami­ca­ble res­o­lu­tion.

A heal­ing cul­ture of com­pas­sion and apol­o­gy needs to replace the deny-and-defend men­tal­i­ty. It is no less a pro­fes­sion­al oblig­a­tion of health­care providers to admin­is­ter emo­tion­al heal­ing to patients (if they have sur­vived) and fam­i­lies in the face of a med­ical error than it is for a doc­tor or nurse to per­form first aid at a crash site.

Research has shown that in many cas­es, all that a patient or fam­i­ly is look­ing for in the after­math of harm is an expla­na­tion for what occurred and an apol­o­gy. A gen­uine and heart­felt apol­o­gy will fre­quent­ly off­set the risk of lit­i­ga­tion. An apol­o­gy is a heal­ing tool. It facil­i­tates clo­sure and reaf­firms a provider’s com­mit­ment to the virtues of com­pas­sion and respect which patient safe­ty lit­er­a­ture con­sis­tent­ly shows is so impor­tant to patients and fam­i­lies who have suf­fered harm. It is also a demon­stra­tion that the health­care provider and those involved in the error have learned from it and have tak­en steps to min­i­mize the risk of it hap­pen­ing again. This, too, is vital to the needs and expec­ta­tions of those who have suf­fered harm.

But apolo­gies must be done in the right way, at the right time, and with the right par­tic­i­pants in the process. Too many health­care providers over­look these com­po­nents. In many cir­cum­stances, an apol­o­gy should be accom­pa­nied by some tan­gi­ble form of finan­cial atone­ment, how­ev­er mod­est, such as a reim­burse­ment of out-of-pocket expens­es, like hos­pi­tal park­ing costs.

Health­care providers that make Patient  Pro­tec­tion 1stSM rec­og­nize the heal­ing pow­ers of an apol­o­gy when they com­mit harm and embed the prin­ci­ples of com­pas­sion, kind­ness and learn­ing it sym­bol­izes into their core val­ues.

Rea­son # 1     It’s called health care — not health harm.

The sta­tus quo is not accept­able and can­not be tol­er­at­ed any longer… it is sim­ply not accept­able for patients to be harmed by the same health care sys­tem that is sup­posed to offer heal­ing and com­fort.

Those words come not from a fam­i­ly harmed by med­ical error but from one of the most pres­ti­gious health­care orga­ni­za­tions in the world. They were set out in the land­mark report of the Insti­tute of Medicine’s review of the state of patient safe­ty in Amer­i­ca, released in 1999.

It is esti­mat­ed that each year, hos­pi­tal harm claims the lives of near­ly half a mil­lion patients in the Unit­ed States and Cana­da. In the U.S. alone, some 15 mil­lion are harmed by hos­pi­tal inci­dents. That’s about 40,000 every day. Thou­sands more die from infec­tions acquired while they are being cared for in U.S. and Cana­di­an hos­pi­tals.  The costs to health­care pay­ers from these avoid­able errors is in the bil­lions.  The dev­as­ta­tion to the fam­i­lies affect­ed is beyond cal­cu­la­tion.

Health­care providers that make Patient  Pro­tec­tion 1stSM acknowl­edge the risk faced by patients in the hos­pi­tal set­ting and the need to com­bat this epi­dem­ic of errors. They take every step and employ every best prac­tice to min­i­mize the risk, while being ful­ly trans­par­ent in dis­clos­ing how they mea­sure up to that chal­lenge and what they are doing about it.

The Cen­ter for Patient  Protection’s cam­paign Keep Me Safe — Make Patient  Pro­tec­tion 1stSM seeks to com­bat the epi­dem­ic of hos­pi­tal harm and encour­age health­care providers to adopt more patient-and-family-centered val­ues, like the ten prin­ci­ples set out above.  

We believe that only when patients and fam­i­lies become ful­ly informed and demand these val­ues, and hos­pi­tals learn to deliv­er them as a fun­da­men­tal stan­dard of care, can there be any gen­uine hope of safer and more pos­i­tive out­comes for patients and fam­i­lies in the health­care set­ting.

 

 

 

 

 

 

 

 

 

 

 

  • What Do You Think?

    If you agree with the prin­ci­ples behind our cam­paign to make Patient Pro­tec­tion 1stSM and why they are so impor­tant to the well-being of patients and fam­i­lies, we would like to hear from you.  

    Only when patients and fam­i­lies become ful­ly informed and insist on these prin­ci­ples of care, and hos­pi­tals learn to deliv­er them as a fun­da­men­tal duty, can there be any gen­uine hope of safer and more pos­i­tive out­comes in the health­care set­ting.

    Let us know what you think.

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    Count Me In for Mak­ing Patient Pro­tec­tion 1st