An Ounce of Prevention

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Patient Safety Self-Assessment Helps Shield Physician Practices Against Liability Exposure

by Dan Bucsko, MBA, MHA, FACHE, ARM, Assistant Vice President, Patient Safety

This quarter, Dan Bucsko describes a comprehensive new patient safety assessment tool for physician offices and introduces MITSS, a nonprofit organization that provides support services to patients, families, and physicians following adverse medical events.—Robin Diamond, JD, RN; AHA Fellow–Patient Safety Leadership; Vice President, Patient Safety.

The Doctors Company is pleased to announce that a new patient safety self-assessment tool for the physician’s office is now available via a link from the Patient Safety/Risk Management section of our Web site. Created by three leading research entities, the Physician Practice Patient Safety Assessment (PPPSA) is a unique tool that you can access without charge at www.physiciansafetytool.org.

The PPPSA allows medical practices to evaluate daily office processes that affect patient safety. Practices that complete the PPPSA will receive a comprehensive workbook that can help identify problem areas and pathways to improvement. Data analysis and benchmarking information are also available for a nominal fee to practices that submit their data online. All data submitted are confidential. Through the use of the PPPSA, practices can:

• clarify opportunities for improvement;
• establish baseline measures of current procedures and evaluate progress over time;
• compare their data to aggregate national data for practices of similar size, structure, or location;
• facilitate conversation and dialogue about patient safety among all levels of staff;
• minimize liability exposure; and
• enable improved care.

The PPPSA allows practices to evaluate their effectiveness and minimize risk across multiple locations in the following areas:

• Medications—appropriate medication history, prescribing, storage, labeling, purchasing, dispensing samples, and administering vaccines
• Handoffs and transitions of patients between clinicians or locations—proper procedures for care coordination to track patients and their clinical information
• Surgery and invasive procedures—patient safety issues relating to ambulatory surgery, especially sedation and anesthesia
• Personnel qualifications and competency—appropriately assessing the qualifications of caregivers
• Patient education and communication—actions that practices can take to help patients understand and carry out their responsibilities
• Practice management and culture—administrative procedures to create a culture of safety.

Eighty individual items are included under these six domains. The practice or group multidisciplinary team discusses the items and evaluates the practice’s success in implementing them. The team then marks one of five boxes on the assessment to indicate the level of implementation for each item. Responses can range from “no activity to implement” to “partially implemented in the practice for some areas” to “fully implemented in the practice for all areas.” Once the self-assessment is completed, a score is developed for each domain, and an overall score is compiled.

Following the completion of the PPPSA, The Doctors Company’s Patient Safety staff will be happy to work with you and your staff to strengthen areas you identify as needing improvement.

“Many errors are preventable if proper patient safety–centered procedures are used throughout the continuum of care, including in physician practices,” says Terry Hammons, MD, MGMA senior fellow. “The task of improving patient safety is shared by all health care settings, but medical practices must take responsibility for learning from each other and keeping their processes current.”

The PPPSA tool was created by the Medical Group Management Association (MGMA), the Health Research and Educational Trust (HRET), and the Institute for Safe Medication Practices (ISMP). The tool’s development and a related study of patient safety in medical groups have been supported by a grant from the Commonwealth Fund.

The MITSS Story: Beyond Disclosure and Apology

Medically Induced Trauma Support Services (MITSS) is a nonprofit organization whose mission is “to support healing and restore hope” to patients, families, and clinicians who have been affected by an adverse medical event or medical error. The organization’s vision is for all those involved in a medically induced trauma to have access to support services. MITSS envisions a more compassionate, patient-centered health care system.

The documentary The MITSS Story is now available on our Web site at www.thedoctors.com/mitss. It chronicles a patient’s and physician’s journey toward healing following an adverse event. Linda Kenney was the patient admitted for an ankle replacement. Dr. Rick van Pelt was the assigned anesthesiologist. No one could have predicted the adverse event that nearly took Linda’s life. No one could have predicted the power of their commitment, collaboration, and resolve to change the system that had failed them.

The MITSS Story is intended to stimulate discussion about the current cultural and institutional barriers that exist throughout the health care arena following adverse medical events around disclosure, apology, and support.

The trend in health care toward full disclosure and apology following adverse medical events is long overdue. Open and honest communication is an ethical obligation and is now recognized as an essential component in systems improvements for patient safety. The health care culture is slowly changing, and disclosure and apology are moving forward.

Almost all adverse medical outcomes have some psychological effect on patients and families. The full impact of some incidents may only become apparent in the longer term. Clinicians often find that they themselves are similarly distressed and can experience symptoms such as sleeplessness, difficulty concentrating, and anxiety.

Health care providers are not routinely trained to deal with the emotional aftermath of an adverse event. Their emotional needs may also be unmet, and clinicians are often left feeling isolated and with a sense of shame, guilt, and incompetence. The fear of medical malpractice allegations may discourage open and honest communication with patients and their families; communication with colleagues is also frequently discouraged. Clinicians are usually expected to return to their routine patient care as though the event never happened.

MITSS believes that support is crucial to facilitating the healing process for all involved. Its long-term strategy is to develop accessible, meaningful support services for clinicians.

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