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Summary

Collaborative Education to Ensure Patient Safety

Continued

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COGME-NACNEP
Recommendations

Throughout the meeting, participants stressed that, if efforts to enhance patient safety are to succeed, there must be close and ongoing collaboration and partnership among physicians, nurses, and all other health care personnel, working together as teams in a systems environment. The meeting participants reached consensus agreement on a set of recommendations, organized by the four IOM themes. These recommendations are guided by a set of principles that emerged during the meeting in response to the findings of the joint meeting. Consensus agreement was reached on these principles:

Principle 1. Patient safety requires the adoption of interdisciplinary practice approaches.

Principle 2. Patient safety gains require revolutionary changes in the education and training of physicians and nurses and in their practice approaches to patient care.

Principle 3. Current system discontinuities need to be eliminated in building a true, safety-oriented system of care.

Principle 4. Patient safety requires significant change in the cultures that guide current medicine and nursing practices.

Principle 5. Patient safety requires that patients become acculturated in the need to participate actively in their own health care.

These principles guided meeting participants in reaching consensus on specific recommendations that are designed to produce the type of major, systemic change needed to achieve levels of patient safety possible given the current state of the art in health care. The recommendations are organized by the themes established in the IOM report to the nation..

IOM Theme 1: Establishing a national focus to create leadership through research, tools, and protocols to enhance the knowledge base about safety

National leadership is needed to provide the resources that will be required to sustain a major systems development that affects the entire health care field. Leadership includes Federal government officials, academic leadership, association leadership, leadership in labor unions, consumer representatives, and all of the major accrediting and licensing/certifying bodies, as well as the leadership in the public and private sector health care practices, insurers and other procurement entities. If the effort to transform the industry is to succeed, a public-private partnership is vital, with all key stakeholders participating in the effort. Specifically, there is need to include business leaders, pharmaceutical industry leaders, and vendors and manufacturers of health-related goods and services. Leadership will provide the resources, but research is vital if the systems are to change intelligently. Because the health care industry acts largely through independent actions by government, academic and health care delivery institutions, many new initiatives are launched over time, but they are not often enough integrated so as to produce the type of knowledge base required for system development.

A. Leadership

The overarching concern of leadership will be to bridge the distinctive cultures of medicine and nursing. Specific recommendations emerging from the meeting regarding the development of leadership on the issue of patient safety include:

1. Convene meetings of deans of professional schools to assure patient safety through interdisciplinary team training. The deans form an especially powerful segment of industry leadership because they command resources, can direct policy changes, and enjoy considerable respect throughout the industry. Without the deans' support, major change of the type being suggested simply will not occur. They are one of the necessary conditions for success.

2. Convene forums of medicine, nursing, and administrative faculties to discuss innovative models and research leading to patient safety.

3. Department of Health and Human Services (DHHS) leadership similarly should convene meetings of agency and bureau leaders who direct the department's substantial health professions training and health care delivery resources to discuss ways in which extant barriers to interdisciplinary team approaches can be eliminated, including the barriers thought to exist through the health care financing systems that support much of health care training and delivery in the country. Changes in the health care financing system would need to encourage team training and practice focused on enhancing patient safety. A revised system needs to account for the value and costs of team training and practice. Financing of graduate education also needs to be adjusted to allow for the initial higher costs of interdisciplinary training sites. Such intragovernmental meetings may eventually have to be broadened to include the private sector.

4. DHHS and industry leadership will need to act in concert to press for the scope of funding support required to build and sustain system change over time. Overall commitment of funds for enhancement of patient safety should be commensurate with current estimates of injuries and deaths among the general public. Because the rate of injury and death is so relatively high when compared to other industries such as aviation, resources devoted to enhancing patient safety may far exceed the levels currently committed to aviation safety.

5. Analogous to the current model for air travel safety, develop a national organizational structure(s) devoted not only to research, error reporting and compilation, but also to: