The alarming report on patient safety crisis in the United States has brought tremendous public awareness which calls for improvement in the quality of care as well as significant changes in the U.S. healthcare system. In 2001, the Institute of Medicine (IOM) launched a program called “A New Health System for the 21st Century” which focused not only on patient safety but on bridging the gap between the right health care and the actual care that people may receive. To modify the quality of care, the Institute of Medicine set the Six Aims for Improvement which served as the framework in re-designing the healthcare system. The six aims focused on new approaches of providing care with the objectives of eliminating flaws in the care of patients.
Healthcare errors are considered critical public health problems in the United States in which the Institute of Medicine accounted an estimate between 44,000 and 98,000 deaths caused by medical errors. Due to the severity of the problem, the need to reduce healthcare errors is essential.
The efforts to realize this goal are faced with barriers which include
wrong perception about healthcare errors, the general pattern of “name” and “blame’ culture, inadequate error-reporting systems and fear of litigation on reported errors. The National Quality Forum (NQF) recommended best practices to reduce the occurrence of healthcare errors as well as patient safety measurements for prevention of medical errors. All healthcare organizations, management and staff, healthcare purchasers and health plans were urged to take various strategic actions to adhere to safety being the fundamental factor of quality healthcare.
Prioritize Patient Safety
Patient safety should be built into the organizational core in which changes in the organizational framework should include appointment of top management leaders responsible for creating a culture of safety through proper implementation of error reporting systems and providing safety training and workshops.
Patient Safety Commitment
Healthcare organizations should establish patient safety programs designed to identify errors and hazards, analyze their causes and set appropriate action for performance improvement.
Culture of Safety
As an integral part of every healthcare organization’s philosophy and values, care should be provided in a safe manner and in a safe environment. Every organization should establish a culture of safety that fosters knowledge and responsibility of the high-risk and error-prone qualities of modern healthcare provide open communication lines on patient safety issues, reports, analysis and resolution of errors.
Healthcare providers should conduct routine assessments or audits using standardized survey instruments to determine error-prone or high risk processes and systems.
Utilizing safe practices recognized by the National Quality Forum (NQF) and Agency for Healthcare Research and Quality (AHRQ) can reduce or eliminate negative events and medical errors.
All healthcare practitioners, management and training programs should evaluate their curriculum on health care errors to ensure that they promote a culture of safety through critical analysis of human factor and engineering designs.
Patient Safety Accountability
Healthcare providers should be held liable for any medical error that occurred and should inform the patient about the error and its causes, apologize and provide restorative measures, conduct a root cause analysis of the error and take actions to prevent re-occurrence.
Professional Misconduct Acknowledgement
Gross negligence, unethical behavior and other forms of professional misconduct are a threat to patient safety and should be
properly dealt with in a timely and decisive manner.
Patient Safety Research
Healthcare organizations should promote patient safety research on hospitals, long term-care facilities and ambulatory care settings through collaboration with pharmaceuticals and medical device industries as well as the federal government for funding support.
Error reporting should be dealt with in an environment that nurtures information sharing and problem solving and one that is free from hierarchical authority and retribution.
Timely Provision of Goods and Services
Timely provision of required goods to location as well as notification of stock-outs and product substitutions will ensure continuous patient care.
Proactive Communication System
Establishing a proactive communication system where care providers should be available 24 hours a day, 7 days a week via e-mail or phone and for timely transmission of alerts, product recalls, service bulletins and news events.
Implement policies on timely access to care that focus on limited waiting time on healthcare appointments, telephone advice and call back time.
Advanced Access Scheduling
Adopting open or advanced access scheduling where appointments were provided on the same day the patient calls can lead to shorter waits and higher levels of continuity of care.
Healthcare should be effective based on systematically acquired evidence and scientific knowledge without overuse or underuse of available techniques. Overuse is the result of unnecessary administration of medications, procedures, surgeries, technologies and visits that is not necessary for the treatment. On the other hand, underuse is the failure to use effective and safe procedure that is necessary for the treatment. One of the common causes of this problem is the extreme dependence of healthcare practitioners on clinical experience rather than evidence in drawing valid conclusions. To obtain an effective delivery of care, clinical guidelines should be implemented through utilization of evidence-based medicine that emphasizes on sophisticated methods of collecting, analyzing and integrating evidence. Effective teamwork and collaboration is also essential in making the right decisions and executing strategic actions for the following support tools:
Employ sophisticated computer systems that can cross-reference symptoms, diagnose and administer medications and monitor patient needs.
Create paper guidelines that are readily accessible and regularly updated which could help in the delivery of information to the point of care and allow care providers to make the right decisions at the right time.
Advanced Techniques and Equipments
Incorporate new techniques, equipments and protocols to apply the best scientific medical knowledge to patients.
In a diverse U.S. population, quality care should not be based on gender, ethnicity, geographic location or socio-economic status. Reports and research showed that disparities on healthcare access, utilization, quality and outcomes are common in underresourced settings that constitute minority populations such as African-Americans, Native Americans, Asian-Americans and Latinos. In addressing these problems, the Agency for Healthcare Research and Quality (AHRQ) enforced evidence-based tools and strategies that can help in achieving an equitable healthcare.
Improving health IT infrastructures could lead to better quality and health outcomes for patients in underresourced settings. IT infrastructures should adopt various styles of approach that acknowledges cultural sensitivity, integration and collaboration among providers, patients and communities.
Disparity Intervention Research
Research studies should be conducted in cooperation with underresourced settings and healthcare IT vendors that focus on increasing patient empowerment, using existing tools and testing electronic medical records and evaluation and maintenance of technology development and policy.
IT Implementation Strategy
Information Technology should be designed to address the problems on social and environmental contexts in underresourced settings, evaluating the healthcare needs of diverse patients, Medicaid or uninsured providers and the use of their networks for effective IT implementation. Conceptualization should foster patient-centered care and effective patient-provider communication.
The aim to achieve efficiency focus on determining good healthcare and that of what people may actually receive which includes two primary methods.
Waste Reduction at all Levels
Waste reduction would require system re-designing that develops competent skills and requirements by providing adequate training and education for staff at all levels. Product utilization should be within the benchmarks of the healthcare system to minimize waste which can be done through conducting reviews. Value analysis and techniques should be the basis for clinical product-decision making, promoting standardization, establishing optimized distribution channels and systems and creating standard policies and procedures in business processes and methods.
Administrative or Production Costs Reduction
Incorporate adequate technologies to promote cost efficiency and productivity in replenishment cycle, thereby, eliminating duplicate paper works and multiple re-entries of practitioner orders. Data standards support and reduction of variability on technology, products and processes will encourage quality, cost-effectiveness and safety.
Patient-centered care is primarily designed to provide a customized care system that promotes transparency and responsibility. Its aim is to provide care that respects and honors patient’s choices, specific needs, culture and values which will serve as the basis for clinical decisions. Efforts to achieve this goal were faced with challenges where primary care physicians are more concerned with increasing patient volume rather than patient experience. Reward incentives for higher volume result to reduction of quality on patient care. In contrary to patient centrism, hospital fragmentation approach to patient care only benefits hospitals and institutions. To encourage patient-centered care, various strategic actions are recommended.
Develop Accountable Care Organizations
Accountable Care Organizations (ACO’s) play an important role by creating patient-centered care models for Medicare and other healthcare insurers. Non-profit organizations such as the Planetree and Picker Institute created Patient-Centered Care Improvement Guide at an advanced level defining healthcare experience that matters most to patients. Patient-Centered care has lesser concerns with clinical, technological and scientific approach but rather giving emphasis on meaningful and memorable aspects such as compassionate interaction, personal relationship, involvement of loved ones and a healing environment that supports mind, body and spirit. The Patient-Centered Improvement Guide is facilitated by a variety of implementation and assessment tools, myths, facts, data and technology strategies. These practices are associated with organizational culture change that requires
long-term commitment, compliance of values, strategies and structures as
well as touching the hearts and minds of patients and care providers.
Reshaping the future of healthcare may not be easy to accomplish due to varying implementation obstacles and inadequate resources. Healthcare organizations and providers should set a commitment to re-design existing systems and processes and establish effective teamwork and collaboration with regional and state hospital associations that can provide essential leadership. Further, the federal government should allocate appropriate funding to support improvement programs, trainings and workshops. The Institute of Medicine believes that a culture of excellence will only occur when these Six Aims for Improvement are successfully addressed.
“Across the Chasm Aim #4: Healthcare Should be Timely”. Institute for Healthcare Improvement. Aug. 10, 2011. Web. October 30, 2013.
Brady, C., Frampton, S. Guastello, S., Hale, M., Smith, S., Stone, S. “About the Patient-Centered Care Improvement Guide”. Patient-Centered Care Improvement Guide. Web. October 30, 2013.
Kizer, K. “Patient Safety: A Call to Action: A Concensus Statement from the National Quality Forum”. Medscape Multispecialty. 2001. Web. October 30, 2013
“Reducing Disparities in Healthcare Quality in Underresourced Settings”. Agency for Healthcare Research and Quality. April, 2010. Web. October 30, 2013.
“Supply Chain Services Professional’s Role in Achieving the Institute of Medicine’s Six Aims for Improvement”. Association for Healthcare Resource and Materials Management. 2013. Web. October 30, 2013. <http://www.ahrmm.org/ahrmm/news_and_issues/issues_and_initiatives/IOM6/