Text­book re­vi­sion

Pa­tient safety must start in class­room: re­port

Modern Healthcare - - The Week In Healthcare - An­dis Robeznieks

Health­care de­liv­ery con­tin­ues to be un­safe and will prob­a­bly re­main that way for some time un­less med­i­cal schools make sub­stan­tial im­prove­ments in how they teach pa­tient safety, ac­cord­ing to Un­met Needs: Teach­ing Physi­cians to Pro­vide Safe Pa­tient Care, a re­port is­sued by the Na­tional Pa­tient Safety Foun­da­tion’s Lu­cian Leape In­sti­tute.

The re­port charges that med­i­cal schools do an in­ad­e­quate job of de­vel­op­ing stu­dent un­der­stand­ing of con­cepts such as sys­tems think­ing, prob­lem anal­y­sis and team col­lab­o­ra­tion that will help them be­come fu­ture ar­chi­tects of pa­tient-safety and qual­ity im­prove­ment ef­forts.

At a news con­fer­ence, the in­sti­tute’s name­sake, Lu­cian Leape, the Har­vard School of Pub­lic Health ad­junct pro­fes­sor of health pol­icy, added that “too of­ten, the stu­dents are be­ing ed­u­cated in a toxic en­vi­ron­ment” where some 5% of physi­cians mistreat stu­dents and oth­ers and are al­lowed to “poi­son the well” and per­pet­u­ate a cul­ture that hin­ders the col­lab­o­ra­tion that is needed for pa­tient-safety learn­ing to oc­cur.

The re­port lists steps schools can take to mit­i­gate th­ese char­ac­ter­is­tics in fu­ture doc­tors by pro­mot­ing at­tributes such as mind­ful­ness, com­pas­sion, em­pa­thy and col­lab­o­ra­tion; screen­ing and iden­ti­fy­ing school ap­pli­cants with “so­cio­pathic ten­den­cies”; and mon­i­tor­ing stu­dents and in­ter­ven­ing early if there are “dis­plays of un­pro­fes­sional or mal­adap­tive be­hav­ior.”

John Prescott, the chief aca­demic of­fi­cer with the As­so­ci­a­tion of Amer­i­can Med­i­cal Colleges, also spoke at the con­fer­ence and said that, “Ed­u­cat­ing new doc­tors about pa­tient safety is a top pri­or­ity” of his or­ga­ni­za­tion and that many of the re­port’s rec­om­men­da­tions have al­ready been im­ple­mented.

The re­port’s au­thors agree some­what and lists 23 med­i­cal schools where im­ple­men­ta­tion has be­gun.

“One would hope that oth­ers will fol­low,” the re­port stated. “But hope is far from suf­fi­cient when the stakes are this high. Some on­go­ing cred­i­ble mech­a­nism is needed to mon­i­tor school progress to­ward, and, later, main­te­nance of achieve­ment of, the ob­jec­tives set forth herein.”

Pa­tient-safety ad­vo­cate Rose­mary Gib­son, au­thor of the books Wall of Si­lence and The Treat­ment Trap (which is sched­uled to be re­leased on March 16), called the re­port “right on tar­get,” and also had praise for the pa­tientsafety fo­cus for one par­tic­u­lar school in­cluded among those listed by the re­port as al­ready beginning the im­ple­men­ta­tion of its rec­om­men­da­tions: the Uni­ver­sity of Illi­nois at Chicago Col­lege of Medicine, which is also the na­tion’s largest med­i­cal school.

In ad­di­tion to its med­i­cal school pro­gram, Gib­son noted how the res­i­dency pro­gram at UIC en­cour­ages pa­tient-safety dis­cus­sions with re­quire­ments for re­port­ing ad­verse events that they ob­serve. “That ap­proach is very rare,” she said. “I think the pur­pose of the Lu­cian Leape re­port is to make those types of ac­tive steps the norm rather than the ex­cep­tion.”

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