A first-of-its kind federal pilot project designed to make it easier for patients to directly complain about medical errors, safety issues, and harm may prompt some doctors and hospitals to blanch.
Might it unleash a gripefest about relatively unimportant aspects of care, like the yucky taste of hospital food, the lack of parking, or meandering laments that one got sick in the first place? A rage against the night?
Are most patients even sophisticated enough about the healthcare system to know a medical error or an unsafe condition when they see one, or how to distinguish it from the natural course of their disease?
With the Office of Inspector General’s estimate that one in four Medicare patients suffers harm at the hands of healthcare providers, could this new information really give providers any more information than by now, they must already know?
We may soon find out.
The pilot project proposed by the federal Agency for Healthcare Research and Quality (AHRQ) intends to give such a harm complaint system a trial run sometime next year, probably in the mid-Atlantic region near Philadelphia. Many say the information it will produce will be a goldmine for quality improvement.
How were you harmed?
Among the proposed queries: Who made the mistake? Where, why, and how? Did it involve a medication, test, or procedure? Was there a delay in care or diagnosis, a problem with anesthesia, or “bad” medical advice?
Patients would be asked how they found out about the error or unsafe condition and the extent to which the harm or error affected them. For example, did it cause them to miss work or pay for more tests and procedures, or make more trips to a healthcare facility?
The proposed questionnaire also asks if providers made any special effort to help patients handle the negative effect, and whether that effort indeed helped.
Providers linked to the incidents would be notified “so they can do a better job.”
According to an analysis of the prototype’s costs, a healthcare organization that received 924 responses or complaints might spend $11,537 logging in the information and conducting follow-ups. The AHRQ project goes way beyond the Hospital Consumer Assessment of Healthcare Providers (HCAHPS) surveys, which ask how patients think they were treated in the hospital, not whether they witnessed errors or harm in the process of their care.
Part of a safety scoring trend
We know medical error and unsafe conditions are of enormous interest to payers and patients, and increasingly to providers. The Leapfrog Group and Consumer Reports this year each launched their own hospital safety rating systems. But those algorithms don’t report actual harmful events as the AHRQ system would.
While a few hospitals around the country may have plans for internal systems to elicit information from patients about harm or errors they experienced, nationally, no such effort yet exists.
A study of inpatients treated at a Boston teaching hospital in 2003 revealed patients can accurately relate problems, mistakes and injuries in their care, including near misses verified, but not documented in the patient’s medical record or its incident reporting system.
I thought the American Hospital Association would be nervous about such an effort. But Nancy Foster, the AHA’s vice president for quality and patient safety policy assures me that such a system can inform the patient care process about problems that providers themselves can’t see.
She likens it to feedback a dissatisfied consumer is able to give to the manufacturer.
“Patients may be most ideally positioned to tell us when they’re getting discordant advice from different clinicians,” Foster says. “Maybe a patient was supposed to go into surgery at 10. They got pre-op medications then. But then the surgery was delayed until 4, and they didn’t get the medications again. They don’t know whether they should have gotten the medications again, but they do know enough to ask the question.”
She acknowledges, however, that there could be “a lot of noise in the data collection, things that aren’t real signals of patient safety issues. And if that’s what AHRQ finds out when it experiments with this, my guess is that they will conclude it wasn’t all it was cracked up to be. They may redo the questionnaire to target concerns more effectively or will abandon the notion.
“But until we try, we really won’t know.”
Potential for arrogance
Barbara Balik, a senior faculty member of the Institute for Healthcare Improvement and a former quality executive with Allina Hospitals and Clinics in Minnesota, was on the AHRQ task force that developed the prototype concept three years ago.
She says research shows that even though patients may not understand the inner workings of the healthcare system, “when they get some signals that something in their care isn’t going well, there’s a strong correlation with the quality and outcomes of care.”
She adds, “I think there’s the potential for arrogance on the healthcare provider side, to say that patients don’t know what they’re talking about. Yes they do. They know what it sounds like, looks like, and feels like from their standpoint, and that’s the voice we have to hear. It’s an amazing source of insight and advantage that we can take advantage of.”
AHRQ officials can’t yet say precisely when or where the prototype will be launched, but I’ll be looking to see how care might improve as a result.
As Foster says, “until we try, we really won’t know.”
Source: Health Leaders Media at http://www.healthleadersmedia.com/page-5/QUA-285596/Medical-Harm-Complaint-System-Could-be-Quality-Data-Goldmine