There are no health facilities, services or units free of professional mistakes. In September 2013, a study published in the Journal of Patient Safety (1) concluded that medical errors cause 440,000 deaths per year, and they are the third leading cause of death in the United States, behind heart disease and cancer.
Our complex Health Care System does not allow a simplistic analysis of mistakes and it is time that begins to overcome those classic etiological settings and investigate further, toward what some authors call the “cause of causes” (2). Notification of incidents, monitoring, analysis and treatment are useful and recognizes that they help mitigate the commission of errors (significantly the repetitions of the same), but it´s insufficient because it has not translated into a general improvement of error rate.
I believe that we must transfer this systemic causal treatment or based on human failings. Safer clinical care can only be achieved when health professionals can interact with patients from a perspective that transcends the illness to focus on the person.
Paradoxically, the increased medicalization of life and its associated problems, induced by a stratified health system and very tech makes every day more unsafe health care that citizens receive.
A holistic care and preventive, in the Quaternary slope, should become as the basis of the predominant philosophy of patient safety programs. It has been found that those who contact wiht the health system directly by the hospital are more likely to be victims of incidents and accidents than those others that are channeled through primary care.
This vision requires a transformation in the formation and behaviour of professionals, pace of change among all we should accelerate. Rather than focus the current model in the patient (although I think that our health care model is organized around institutional and professional interests) we should be modelled around people. We must give them the option to participate and make decisions.
In more than a decade little progress has been made. As much as we have determined the active principle that can improve a symptom but not the mechanism of action that leads to the genesis of many side effects. There is uncertainty about the results of the many initiatives (laudable all of them) that have been launched to improve safety of patients.
I would like to remind the little value which is granted to the ‘no-action’ although it is a tool with a great future. A shallow form of reading reality is to be considered as successful results must act. The evolution of this crisis that we are experiencing has enhanced the passivity as a high-value strategy. Consider a passionate, intense and on inaction focused on the person rather than the patient. After all, and despite an old system, one of the things that are most effective and quasi-revolutionary, is the passion with which the professional can exercise their profession and the relationship “face to face” that the other person (your “patient”). The rest is a mediator in the magical event of the passionate relationship between the health professional and the patient. Not lose it: We must recover it. For the safety; by ours.
The evolution of this becoming “not humanist” (cave) will be a refinement of control technologies at ‘foolproof devices’ with a system increasingly vulnerable to at least one body accident. Does it serve us a sample the ebola crisis?. A planet of health formalized and tech will be at the mercy of a single body with a definitely lethal character.
The initial enthusiasm for safety of the patients was accompanied by a magical maze in search of solutions for the professional mistake. We sin of uppercase naïve even despite the fact that the adoption of other sectors more insurance tools (aviation, nuclear, etc.) and own culture of safety, more than embryonic phase, have managed to make the safety of the patients usual in strategic health systems speeches.
Low adherence to these programs, the limited scope of interventions and their basement in a low evidence have done that strategies initiated will fail, at least in terms of results. We could equally invoke as reasons for the lack of success, interventions targeting hospitals (and not to primary care), acute illness processes and prevention, above others, media errors or bulk (wrong side, medication errors).
A broad view of safety of patients would be the one that considered adverse events, not as individual episodes, but failures accumulated during the journey of the person along the route of health. Healthcare professionals understand more about avoidable problems than indicators or scorecards. Strategic efforts are still going is this way ignoring that small local victories that fill the gap of humanization that reigns in our centers are much more effective, balancing the evidence and experience with the pursuit of knowledge that may lead to the patient safety through the humanism, almost always relegated. We are in a model of enlightened despotism as insistently put the emphasis in that everything we do, we do centered on the patient without having them in consideration (obviously their views, their expectations and their experience of illness).
The attention conditions that favor the credibility include commitment, empathy (listening, understand their thoughts and emotions) and honesty (professional credibility). To be in a humanized system requires to use freedom as sick, as a patient, as a person and as a citizen (3)..
Welcome to The IC-HU Project. Your hits would be estimate by whom be surprised with your news. In our activity we can decide between two great choices: to reinvent ourselves or prepare for a slow decline.
Extendethe project among other units and services. Patients safety then will be effective. The other, still necessary, has yet to be demonstrated.
Thank you on behalf of all those who are concerned about patients safety .
José María Ruiz Ortega
1. A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care. J Patient Saf. September 2013 – Volume 9 – Issue 3 – p 122–128
2. Complexity science: The challenge of complexity in health care. Plsek y Greenhalgh, BMJ. 2001 Sep 15;323(7313):625-8.
3. Humanización en la asistencia clínica oncológica. Javier García-Conde, Ana García-Conde. Psicooncología. Vol. 2, Núm. 1, 2005, pp. 149-156.
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