TMA Advantage: TMA Tackles Patient Safety Through Team Approach



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Cover Story Sidebar - October 2000  

Physicians' concerns over patient safety and quality care are nothing new, despite what the headlines inspired by the Institute of Medicine (IOM) and the Public Citizen's Health Research Group would lead most people to believe. Measures to reduce medical errors were enacted long before the IOM report. (See "Patient Safety in America: Comparison and Analysis of National and Texas Patient Safety Research.")

"Patient safety and patient advocacy always have been at the forefront of the Texas Medical Association's efforts," said Tyler anesthesiologist Asa Lockhart, MD, a member of TMA's Workgroup on Patient Safety and Council on Legislation.

But new patient safety fears require new approaches in hospitals and physician offices. That's why TMA is collaborating with the Texas Nurses Association, Texas Pharmacy Association, Texas Society of Hospital System Pharmacists, and Texas Hospital Association to help create a safe environment in which to report and learn from errors as well as pull together some legislative strategies for the 2001 session (see "Outlawing Mistakes," March 2000 Texas Medicine , pp 26-31).

During a July meeting in Austin, members of the five associations explored the unique issues that each faces in reporting medical errors. For example, many of the physicians in attendance did not realize how punitive the nurse reporting system was. "They've got a three-strikes-and-you're-out approach -- even if they're all three tipped balls," Dr Lockhart said.

Now the medical community is trying to shift the emphasis from the individual to the system and from a culture of blame to a culture of education.

"In the past, we were very much stuck on who's to blame," said Houston gynecological oncologist Charles Levenback, MD, medical director of quality for The University of Texas M.D. Anderson Cancer Center. "If you're a doctor, blame the nurse. If you're a nurse, blame the doctor. If you're a pharmacist, blame the dogcatcher. But now we find people are coming to us with adverse events saying, 'Something bad happened and we need help so it never happens again.'"

As cries for a mandatory reporting system grow louder and threaten the reporting progress made in nonpunitive environments, physicians need to get involved in the policymaking process, Dr Lockhart says.

"We have to take a very proactive role," he said. "We don't want to leave a void for others to determine what our patient safety initiatives should be. Doing nothing is not an option."

Dr Lockhart adds the workgroup is anxious to hear comments about what has and has not worked in the realm of patient safety initiatives. Please forward your comments to Karen Batory, director of the TMA Division of Public Health and Quality, at (800) 880-1300, ext 1405, or (512) 370-1405; or karen.batory[at]texmed[dot]org.

Patient safety reporting principles  

TMA has adopted the following general principles for patient safety reporting systems.

Creating an environment for safety: There should be a nonpunitive culture for reporting health care errors that focuses on preventing and correcting systems failures and not on individual or organization culpability.

  • Health care professionals and organizations should foster a positive atmosphere that encourages submitting health care error reports to public or private oversight organizations, accrediting bodies, or other generally recognized patient safety reporting systems. The existence of a reporting system does not relieve health care professionals and organizations of their responsibility to maintain professionally recognized standards of care.

Data analysis: Information submitted to reporting systems must be analyzed comprehensively to identify actions that would minimize the risk that reported events recur.

  • Systems within organizations should be scrutinized to identify actions to prevent future errors. Effective procedures and/or protocols developed through reporting systems should be compiled and widely disseminated to all health care professionals and organizations.

Confidentiality: Confidentiality protections for patients, health care professionals, and health care organizations are essential for reporting systems to learn about and reduce errors.

  • Reporting systems should protect the identity of individual patients and abide by all relevant confidentiality laws and regulations. The identities of health care professionals and organizations involved in errors should not be disclosed outside a reporting system without consent.

Information sharing: Reporting systems should facilitate sharing patient safety information among health care organizations and foster confidential collaboration with other health reporting systems.

  • Sharing information is fundamental to a reporting system's ability to achieve widespread improvements in patient safety and to instill a confidence in the public that safety issues are being addressed. Sharing of error-related information is subject to the confidentiality principle.
  • The causes of errors and their solutions must be shared widely so that all health care organizations can learn from the experiences of others.
  • In some circumstances, it will be desirable to share reports of errors among reporting systems, and with other appropriate quality improvement entities, to accomplish root-cause analyses, to construct action plans, and to engage in other efforts to enhance patient safety.

Legal status of reporting system information: The absence of federal protection for information submitted to patient safety reporting systems discourages the use of such systems, which reduces the opportunity to identify trends and implement corrective measures. Information developed in connection with reporting systems should be privileged for purposes of federal and state judicial proceedings in civil matters, and for purposes of federal and state administrative proceedings, including with respect to discovery, subpoenas, testimony, or any other form of disclosure.

  • Scope. The privilege for the information prepared for a reporting system should extend to any data, report, memorandum, analysis, statement, or other communication developed for the purposes of the system. This privilege should not interfere with the disclosure of information that is otherwise available, including the right of individuals to access their own medical records.
  • No waiver. Submitting health care error information to a reporting system, or the sharing of information by health care organizations or reporting systems with third parties in accordance with these principles, should not be construed as waiving this privilege or any other privilege under federal or state law that exists with respect to the information.
  • Freedom of Information Act. Health care error information received by and from reporting systems should be exempt from the Freedom of Information Act and other similar state laws. Such an exemption is necessary to preserve the privilege discussed in this principle.
  • Impact on state law. A federal law is necessary to assure protection of information submitted to national reporting systems, but the federal protection should not preempt state evidentiary laws that provide greater protection than federal law. Providing such information to reporting systems should not constitute a waiver of any state law privilege.

For more information, see the special section on patient safety on the TMA Web site.

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